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NC Division of Medical Assistance Outpatient Pharmacy Prior Approval Criteria Antinarcolepsy/Antihyperkinesis Agents Medicaid and Health Choice Effective Date: March 4, 2002 Amended Date: May 22, 2018 Therapeutic Class Code: H8Q nuvigil rash nuvigil vs provigil adhd nuvigil vs adderall xr nuvigil or adderall nuvigil depression Therapeutic Class Description: Antinarcolepsy/Antihyperkinesis Agents Generic Code Number(s) Provigil, modafinil Nuvigil, armodafinil 98590, 98591, 98592, 36082 Eligible Beneficiaries NC Medicaid (Medicaid) beneficiaries shall be enrolled on the date of service and may have service restrictions due to their eligibility category that would make them ineligible for this service .
NC Health Choice (NCHC) beneficiaries, ages 6 nuvigil through 18 years of age, shall be enrolled on the date of service to be eligible, and must meet policy coverage criteria, unless otherwise specified .
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