Pharmacy Lock-in Program

Per general statute 108A‑68.2. Beneficiary Lock‑in Program for Certain Controlled Substances, AmeriHealth Caritas North Carolina's (ACNC's) Pharmacy Lock-in Program assigns members to a single prescribing provider and pharmacy to monitor, prevent and reduce the misuse of pharmacy services.

Members may be identified to enter into the lock-in program if any of the following criteria are met:

• They have filled ten or more prescriptions for covered substances in a period of two consecutive months when not medically necessary.
• They have received prescriptions for covered substances from four or more prescribers in a period of two consecutive months when not medically necessary.

Members will be notified in writing that they will be subject to the lock-in program and also have the opportunity to select a single prescriber and pharmacy. Members can appeal the pharmacy lock-in decision within 60 calendar days from the date listed on the ACNC Pharmacy Lock-In Program notification. For more information, follow the procedures as outlined in the Appeals section of the Member handbook.