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NC Department of Health and Human Services
NC Division of
Medical Assistance

Enhanced Specialty Discount on Single-Source Specialty Drugs

Effective with date of service October 10, 2008, the N.C. Medicaid Outpatient Pharmacy Program will utilize a State-determined upper payment limit for select single-source specialty drugs that cost in excess of $1,500 per month.  This is in compliance with a N.C. General Assembly mandate in Session Law 2008-107, Section 10.10(e).  Specialty drugs in the following therapy categories will be affected:

  • Anemia/neutropenia
  • Anticoagulants
  • Enzyme replacement
  • Growth hormones
  • Hemophilia
  • Hepatitis
  • HIV
  • Hyperparathyroidism
  • Immune deficiency
  • Immune globulins
  • Immunosuppressives
  • Multiple sclerosis
  • Oncology
  • Osteoporosis
  • Psoriasis
  • Pulmonary
  • Rheumatoid arthritis
  • Other miscellaneous

The list of specialty drugs that are affected by this upper payment limit is updated on a quarterly basis.  Please refer to Enhanced Specialty Pricing (PDF, 56KB) (updated March 5, 2013) for the list of specialty drugs affected by the new upper payment limit.