Pharmacy Lock-in Program

AmeriHealth Caritas North Carolina's Pharmacy Lock-in program assigns members to a single prescribing provider and pharmacy to monitor, prevent and reduce the misuse of pharmacy services.

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

• Have filled six or more prescriptions for covered substances in a period of two consecutive months.
• Have received prescriptions for covered substances from three or more providers in a period of two consecutive months.
• Are recommended as a candidate for the lock-in program by a provider

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 have the opportunity to appeal the pharmacy lock-in decision within 60 days by following the procedures as outlined in the Appeals section in the Member handbook.

Provider referrals

Providers can refer members to our lock-in program if they suspect misuse, abuse, or potential fraud of pharmacy services. If you suspect member fraud, misuse, or abuse of services, you are encouraged to make a referral to the Pharmacy Lock-In program by calling the Fraud Tip Line at 1-866-833-9718.