Pharmacy Initiatives

Prescription Advantage List (PAL)

The Prescription Advantage List (PAL) was developed by the North Carolina Physicians’ Advisory Group (NCPAG) and Community Care of North Carolina, in cooperation with the state's Division of Medical Assistance, as an effort to control rising pharmacy costs in North Carolina Medicaid. The voluntary list is a guide for physicians to prescribe less expensive medications whenever possible and clinically appropriate. By evaluating the actual net cost of each medication to North Carolina Medicaid (including rebates), the medications in each class are ranked in order from least expensive to most expensive, as determined by the NCPAG. No judgment as to efficacy is implied by this list; rather, it is intended as an educational tool based on cost alone.

Pharmacist Referral Program

In 2003, AccessCare began its PolyPharmacy initiative to address the high costs of drugs used by nursing home patients.  Pharmacy consultants reviewed prescription regimens of all Medicaid and dual eligible nursing home patients and made recommendations to physicians in order to optimize overall drug management and reduce costs where appropriate.  These efforts led to not only millions of dollars in reduced drug costs, but improved patient health care due to the reduction of duplicate drugs and fewer adverse drug-drug interactions.  The initiative continues with annual drug review efforts in nursing homes in order to maintain cost effective and high-quality drug regimen solutions for patients.

Standing Orders

Two drug classes that present the biggest opportunity for cost-savings to the Medicaid program are Proton Pump Inhibitors (PPI) and Non-sedating Antihistamines (NSA). In 2003, North Carolina Medicaid added over-the-counter (OTC) Prilosec and loratadine to the list of covered drugs. However, providers soon had difficulty writing and filling prescriptions for these OTC medications. As a result, AccessCare developed Standing Order arrangements between practices in selected network counties and their local pharmacies. The order permits pharmacies to fill or refill any prescription for a Medicaid patient of an affiliated practice for a non-over-the-counter PPI or NSA with an over-the-counter medication. Physicians are still able to specify “Do Not Substitute” on the prescription if there is a medical necessity for the originally prescribed product.