Pharmacy

WellCare of North Carolina is committed to working with providers to improve members' health and well-being.

The following information will help your patients get the most out of their pharmacy benefits.

Coverage Determination Request

The coverage determination process enables providers to request an addition or exception.

• Electronic Prior Authorization (ePA): Cover My Meds
• Online Form: Request Prescription Drug Coverage
• Pharmacy Prior Authorization Forms

Medication Appeals

Providers may appeal a coverage determination decision by contacting our Pharmacy Appeals department via fax, mail, in person or phone. Please refer to the Quick Reference Guide for instructions.

• Online Form: Request Appeal for Drug Coverage

Preferred Drug List (PDL)

The Preferred Drug List (PDL) is the list of drugs covered by WellCare of North Carolina. WellCare of North Carolina asks that doctors prescribe medications from the NC Medicaid Preferred Drug List (PDL) for their patients who are members of WellCare of North Carolina. Some drugs will need your doctor to ask for prior approval before the medication can be given to you at the pharmacy. Please check back for updates, as PDLs are periodically amended.

• PDL Changes (PDF)
• PDL Changes October 1, 2025 (PDF)
• Search for a Drug

The NC Medicaid Preferred Drug List (PDL) allows NC Medicaid to obtain better prices for covered outpatient drugs through supplemental rebates. The PDL was authorized by the NC General Assembly Session Law 2009-451, Sections 10.66(a)-(d).

• Prescribers are encouraged to write prescriptions for "preferred" products.
• Prescribers may continue to write prescriptions for drugs not on the PDL.
• If a prescriber deems that the patient's clinical status necessitates therapy with a non-preferred drug, the prescriber will be responsible for initiating a prior authorization request.
• Prior authorization requirements may be added to additional drugs in the future.
• Submit Proposed Clinical Policy Changes to the PDL
• Preferred Drug List Review Panel

Printed Preferred Drug Lists

• North Carolina Preferred Drug List

Outpatient Pharmacy Services

• Outpatient Pharmacy Policies (9, 9A, 9B, 9D and 9E)
• Updates to NC Medicaid Coverage for Wegovy and Zepbound for Clinical Indications other than Weight Loss

Cell & Gene Therapy Prior Approval (PA) Criteria

Please review Clinical Coverage Policy 1S-13 Cell & Gene Therapies prior to submitting a prior approval (PA).

View PA criteria for individual cell and gene therapies.

For information regarding the billing of State-Selected Model Drugs, please refer to the guidance under the section: 3.12.3 Clinical Services Billing and Reimbursement Guidance for NC Select Drugs (including Cell & Gene Therapies).

For more information regarding the NC Select Drug List, please refer to the Inpatient/Outpatient Pharmacy Services page.

Additional Information