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Covered Pharmacy Benefits

Covered Pharmacy Benefits

‘I am a pharmacist’ - Partners Tailored Plan
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Partners Tailored Plan works with the North Carolina Department of Health and Human Services (NCDHHS) to help make sure medicines for many health conditions are covered.

Covered Medications

Partners Tailored Plan follows the NC Medicaid Preferred Drug List (PDL). This list includes medicines you can get at regular drugstores.

  • The PDL helps NC Medicaid get lower prices for covered medicines by working with drug companies.
  • Doctors are encouraged to prescribe medicines that are on the PDL, called “preferred” drugs.
    But doctors can still prescribe drugs that are not on the list.
  • If a doctor thinks a patient needs a drug that is not on the PDL, they must ask for approval first. This is called “prior authorization.“
  • More drugs may need prior authorization in the future, and the rules for getting approval may change.

To find out if your medicine is covered, use our search tool to look it up on the drug list. This list is called the “drug formulary.” The tool will also show if there are any limits on the medicine. To access the Partners Drug Formulary:

Preferred Drug List (PDL) Updates Effective Oct. 1, 2025

  • GLP-1 medications: Wegovy, Zepbound, and Saxenda are no longer covered for weight management. Wegovy and Zepbound may be covered with prior authorization for limited FDA-approved uses; Saxenda is no longer covered for any indication. GLP-1 medications for diabetes remain covered.

  • ADHD medications: Adderall XR, Apetensio XR, Concerta, Focalin XR, and Methylphenidate ER (generic) are now non-preferred and require prior authorization after trials of two preferred alternatives.

  • Insulin products: Humalog, Novolog, and Levemir (multiple forms) are now non-preferred and require prior authorization after trial of at least one preferred insulin.

  • Spravato® (esketamine): Covered through the Physician Administered Drug Program (PADP) for treatment-resistant depression and major depressive disorder with acute suicidal ideation or behavior. Prescribers and facilities must be REMS certified.

Read the full description in the Provider Communication Bulletin

Preferred Drug List

The Preferred Drug List (PDL) is a list of medicines your doctor will try first when giving you a prescription. These drugs were picked because they work well and are safe.

  • Most of the time, your doctor can prescribe these medicines without needing to get approval from us first. This is called “prior authorization.”
  • The PDL is updated often. The plan also covers some over-the-counter (OTC) items, like certain allergy and heartburn medicines.
  • To see the full list of covered drugs—including brand-name, generic, and OTC items—click the link below to view the full PDL.

Preferred Drug List (PDL)

For Providers:
Providers should use the PDL when prescribing for Partners Health Management members. The PDL shows the preferred drugs in the most commonly used categories, but it is not a full list of all drugs.

Some medicines on the list may still need prior approval or must meet certain medical rules before they can be used.