PDL and Prior Authorization

NCPA’s Executive Council convened a task force in 2015 on prior authorizations (PAs) and the Medicaid preferred drug list (PDL) in response to members’ concerns about the ever-increasing number of prior authorizations being required by insurers. We've compiled several resources to assist with PAs (including appeals) and have developed guidelines for responsible prescribing. 

Filing Complaints with DOI

• NCPA receives questions from members on how to make a complaint to the NC Department of Insurance regarding health insurance matters, both for providers and patients. DOI has two mechanisms for this:
• Consumers - Call 855-408-1212 about any type of insurance issue (including health
• Providers - View provider guidance and use the Complaint Form to submit complaints

• Template Provider Complaint Letter

Guidelines for Responsible Prescribing 

• 2014 PDL Response on PA Limits for Antipsychotics 
• Prescribing ADHD Medications

Medicaid PA Request Form

• DMA Prior Auth Request Form