Proposed Medicaid and NC Health Choice Policies

NCGS §108A-54.2 requires that the Department of Health and Human Services consult with and seek the advice of the North Carolina Physician Advisory Group and other professional societies and organizations in developing new or amended Medicaid clinical coverage policies. The law requires the Department to publish proposed new and amended clinical coverage policies on the Department's website and accept oral and written comments. All consultations and comments are considered. The Department has delegated to the DMA Division Director the authority to make the final decisions regarding clinical coverage policies.

The following proposed new or amended Medicaid and NC Health Choice clinical coverage policies are available for review. Comments on proposed polices may be submitted by clicking the envelope next to each proposed policy. Comments and questions not specifically related to the proposed policy should not be sent to this Web address. The initial comment period for each proposed policy is 45 days. An additional 15-day comment period follows if a proposed policy is substantively revised as a result of the initial comment period. If the adoption of a new or amended medical coverage policy is necessitated by an act of the General Assembly or a change in federal law, then the 45- and 15-day time periods shall instead be 30- and 10-day time periods.

Proposed Policy Date Posted Submit Comments Comment Period End Date

1K-7, Prior Approval for Imaging Services

11/06/15 12/06/15

Clinical Edits - Behavioral Health Pediatric

11/06/15 12/21/15
Clinical Edits - Behavioral Health Adult 11/06/15 12/21/15

Prior Approval Criteria - Growth Hormones

11/06/15 12/21/15

Preferred Drug List (PDL)

11/06/15 12/21/15

Prior Approval Criteria - Triptans

11/06/15 12/21/15
The NC Physician Advisory Group has recommended that the proposed policies listed below be terminated.

Prior Approval Criteria - Brand-Name Drugs (DAW1) - Termination

11/06/15 12/21/15

Prior Approval Criteria - Incivek (telaprevir) - Termination

11/06/15 12/21/15
Prior Approval Criteria - Victrelis (boceprevir) - Termination 11/06/15 12/21/15
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