Prior Authorization in North Carolina
North Carolina enacted HB 149 (2023) requiring step therapy exception processes. Exceptions must be provided for contraindications, prior treatment failures, and expected inefficacy. The state requires PA decisions within specified timeframes and provides external review.
Key Facts About PA in North Carolina
- ✓ Step therapy exception process required under 2023 legislation
- ✓ PA decisions must be communicated within a reasonable timeframe
- ✓ External review available through the NC Department of Insurance
- ✓ Blue Cross Blue Shield of NC is the dominant commercial carrier
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in North Carolina
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these North Carolina carriers:
BCBS of North CarolinaUnitedHealthcareAetnaCigna