Medicare drug coverage in North Carolina: 24 drugs, plain English

How Medicare drug coverage works

Medicare splits drug coverage between two parts:

• Part D covers most prescription drugs you take at home: pills, inhalers and pens or syringes you inject yourself. You get it from a standalone Part D plan (with Original Medicare) or from a Medicare Advantage plan that includes drug coverage. Each plan has its own formulary (drug list), tiers, pharmacy network and rules such as prior authorization.
• Part B covers a limited set of outpatient drugs, mostly ones you don't usually give yourself, such as injections and infusions a clinician gives in a doctor's office or hospital outpatient setting (Eylea eye injections, for example), plus drugs used with equipment like a nebulizer or an insulin pump, and certain injectable osteoporosis drugs.

The same drug can fall under either part depending on how it's given. Stelara is an example: the IV starting dose in a clinic is Part B, and the injections you give yourself at home are Part D. Part A covers drugs only as part of an inpatient stay.

What changes for drug coverage in 2027

The 24 drugs

Each page answers "Does Medicare cover it in North Carolina?": which part covers it, its negotiation status, generics or biosimilars, the cost protections that apply and how to check a plan.

"Negotiated price" means CMS set a maximum fair price under the Medicare Drug Price Negotiation Program. It's what plans and pharmacies pay, not your copay. In January 2026 CMS selected 15 more drugs, including Trulicity, for prices that take effect in 2028. See Which drugs have Medicare negotiated prices in 2027?

Drug coverage in North Carolina

North Carolina is its own Part D region (PDP Region 08), so each standalone Part D plan sold here is offered in all 100 counties. For 2027, CMS lists 11 standalone Part D plans from 6 companies. Medicare Advantage choices, most with drug coverage, run from 11 plans in Carteret County to 57 in Guilford County. See How many Part D plans are in North Carolina for 2027? and North Carolina counties.

• No state drug program for seniors in general. North Carolina's only state pharmaceutical assistance program is part of the HIV Medication Assistance Program (HMAP), which pays Part D out-of-pocket drug costs for eligible members. See Does North Carolina have a prescription assistance program for seniors?
• Full NC Medicaid and Medicare: your drugs come through Medicare drug coverage with Extra Help built in, not through NC Medicaid Direct. People with MQB get Extra Help automatically too. See NC Medicaid and Medicare.
• State Health Plan retirees: the Base Plan and Enhanced Plan include group drug coverage. Joining an outside Part D plan moves you off the group Medicare Advantage plan to the 70/30 Plan. See State Health Plan retirees and Medicare.
• After a hurricane or flood: CMS expects Part D plans to cover replacements for prescriptions lost or destroyed in a disaster. See hurricanes, floods and Medicare.
• If your Medicare Advantage plan ends in 2027, see plans ending in 2027 to choose new drug coverage without a gap.

How to check a plan's coverage for your drugs

1. List every drug. Exact name, strength and how often you take it.
2. Look them up. Enter them with your ZIP code on PlanMatch or Medicare.gov's Plan Finder to see each plan's formulary and rules.
3. Read your 2027 Annual Notice of Change. It lists formulary changes for next year. Open Enrollment runs October 15 to December 7, 2026.
4. Get help if you want it. You can request a call from a licensed insurance agent, who can compare plans from the companies they work with, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for information on all of your options.

If your drug isn't covered or a charge looks wrong

• Ask your plan for an exception. A formulary exception if the drug isn't covered, or a tiering exception if it's on a high tier. Your prescriber supports the request. See Medicare appeals in North Carolina.
• Medicare questions: 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) or Medicare.gov.
• Suspected billing errors or fraud: the Senior Medicare Patrol national line, 1-877-808-2468. See Medicare fraud in North Carolina.
• Extra Help applications: Social Security, 1-800-772-1213 (TTY 1-800-325-0778). See Extra Help in North Carolina.

Sources

• Medicare.gov — Drug coverage (Part D)
• Medicare.gov — How much does Medicare drug coverage cost?
• Medicare.gov — Prescription drugs (outpatient) under Part B
• Medicare.gov — Shingles vaccines
• CMS — CY 2027 Rate Announcement (2027 Part D deductible and out-of-pocket threshold)
• CMS — Selected drugs and negotiated prices (including drugs with deselection determinations)
• CMS — Selected drugs for initial price applicability year 2028 (January 2026)
• CMS — Medicare GLP-1 Bridge
• Medicare.gov — Weight loss drugs (Medicare GLP-1 Bridge)
• Medicare.gov — Medicare Prescription Payment Plan
• Social Security — Extra Help with Medicare prescription drug plan costs
• CMS — Medicare Advantage and Part D Landscape files, 2027 (PDP Region 08: North Carolina)
• NCDHHS — HIV Medication Assistance Program manual (SPAP), October 6, 2026
• CMS — Replacing Durable Medical Equipment and Prescription Drugs after a Disaster

Frequently asked questions

Medicare in your North Carolina county

Plans, local agents and help, county by county: Wake · Mecklenburg · Guilford · Forsyth · Durham · Cumberland · Buncombe · Union · Johnston · Cabarrus · New Hanover · Gaston · Onslow · Iredell · Alamance · Pitt · Davidson · Brunswick · Catawba · Rowan · All 100 counties →