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NC DMA: 1B, Physician's Drug Program - NC Department of Health - ncdhhs

NC DMA: 1B, Physician's Drug Program - NC Department of Health - ncdhhs 2025

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The document outlines the North Carolina Division of Medical Assistance's Physician’s Drug Program (PDP) for Medicaid and Health Choice, detailing coverage policies for injectable drugs administered in outpatient settings. It specifies eligibility requirements, criteria for coverage and non-coverage, prior approval processes, provider qualifications, and billing guidelines. Special provisions for beneficiaries under 21 years of age are included, along with information on drug restrictions and limitations. The policy aims to ensure that medically necessary services are provided while adhering to state and federal regulations.

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