Prescription Medication Coverage
Partners Health Management covers most prescription medications.
Some medications need prior authorization which means your provider must get approval before the medication is covered. Some prescriptions may also have limits, such as:
- Age requirements
- Dose (how much you take)
- Quantity (how much you can receive at one time)
Partners also covers some over-the-counter medications when they are prescribed by a Partners network provider.
Pharmacy Services and Support
Partners works with CVS Caremark®, a pharmacy benefits manager (PBM). A PBM helps manage prescription drug coverage for Medicaid members enrolled in the Behavioral Health (BH) and Intellectual/Developmental Disabilities (I/DD) Tailored Plan.
CVS Caremark supports Medicaid members in many states and helps process pharmacy claims and approvals. Members can view their pharmacy claims information through the CVS Caremark member portal.
Contact Information
If you have questions about your medications, coverage or pharmacy benefits, CVS Caremark® offers a 24/7 toll-free help line for members, providers and pharmacies.
Call 1-866-453-7196
Available 24 hours a day, 7 days a week
NC Medicaid Reinstates Coverage of GLP-1 Medications for Weight Management
NC Medicaid is again covering certain GLP-1 medications for weight management, effective immediately.
This means coverage has returned to the rules that were in place on Sept. 30, 2025, based on direction from the Governor of North Carolina.
This update applies to:
- NC Medicaid Direct (members not enrolled in a health plan), and
- NC Medicaid Managed Care (members enrolled in a health plan)
GLP-1 medications are prescription drugs that help with weight management by affecting appetite and blood sugar. Coverage is restored under the NC Medicaid Outpatient Pharmacy Prior Approval Criteria for GLP-1s for Weight Management, which explains who can receive these medications and under what conditions.
What’s Changing
- Wegovy, Zepbound and Saxenda are once again included on the Preferred Drug List (PDL).
- The PDL is the list of medications NC Medicaid covers.
- Wegovy is a preferred medication, meaning it is usually easier to get.
- Zepbound and Saxenda are non-preferred, which may require extra approval.
- Clinical criteria (the medical rules used to decide coverage) for GLP-1 medications for weight management have been restored in NCTracks, the system NC Medicaid uses to manage claims and approvals.
- Prior authorization requests can now be submitted right away.
- Prior authorization means a provider must get approval from Medicaid before the medication is covered.
Continued Coverage for Other Uses of GLP-1 Medications
NC Medicaid continues to cover Wegovy and Zepbound for uses other than weight loss, when prescribed for FDA-approved medical reasons, including:
- Lowering the risk of serious heart problems (such as heart attack or stroke) in adults who have heart disease and also have obesity or are overweight
- Treatment of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), a serious liver disease, in adults with moderate to advanced liver scarring
- Treatment of moderate to severe obstructive sleep apnea, a condition that causes breathing to stop and start during sleep, in adults with obesity
Coverage for these uses follows FDA approval and NC Medicaid policy.
For Pharmacy Use
Pharmacies can find processing information and pharmacy help lines for all NC Medicaid Fee-for-Service, Standard Plans and Tailored Plans on the NC Department of Health and Human Services (NCDHHS) website.
Partners Pharmacy Processing Information
- Managed Care Organization (MCO): Partners Health Management
- Pharmacy Benefits Manager (PBM): CVS Caremark
- BIN: 025052
- PCN: MCAIDADV
- Group Number: RX22AC
- Pharmacy Benefits FAQs
Answers to common questions about pharmacy coverage and billing. - NC Medicaid Pharmacy Services
The North Carolina Medicaid Division of Health Benefits (DHB) website includes detailed information about outpatient pharmacy services, coverage rules and updates. - Prior Authorization and Drug Coverage
The NC DHHS website lists medications that require prior approval, along with the criteria needed for approval. Click the Link and go to Pharmacy Services Clinical Coverage Policies to locate medications and criteria. - Clinical Coverage Policies
The North Carolina Medicaid Division of Health Benefits website also includes all NC Medicaid Clinical Coverage Policies, which explain coverage requirements for services and medications.