North Carolina State Health Plan Moves to a Custom Closed Formulary for 2017

The North Carolina State Health Plan (SHP) is transitioning its pharmacy benefits manager from Express Scripts to CVS Caremark. The plan will also move to a custom, closed formulary, meaning some drugs will no longer be covered. Both changes are effective January 1, 2017. 

Please talk to your patients who have SHP coverage, and review their current prescriptions to see if they are affected by these changes. 

If you feel it is medically-necessary for a patient to remain on a non-covered drug, you can request an exception. Requests for exceptions will not be accepted before January 1, 2017, so affected SHP members must plan ahead. Early notification helps avoid delays and ensures your patients receive their medications in a timely manner. 

While some drugs may no longer be covered, others may:

• Require prior approval
  • Beginning January 1, you can call 1-800-294-5979 to request prior authorization.
  • Approval must be received before the patient fills the prescription.
• Require step therapy
• Be subject to quantity limits 

The 2017 North Carolina State Health Plan Preferred Drug List may be found here.