Bill > H163

This bill establishes comprehensive regulations for pharmacy benefits managers (PBMs) in North Carolina, addressing multiple aspects of their operations to protect pharmacies and consumers. The bill prohibits "spread pricing," where PBMs charge insurers more for prescription drugs than they pay pharmacies, and requires PBMs to report all concessions and rebates received from drug manufacturers. It strengthens pharmacy rights by preventing PBMs from imposing unfair fees, reducing reimbursements, or restricting pharmacy participation in networks, particularly for specialty pharmacies. The legislation clarifies consumers' right to choose their preferred pharmacy, ensuring that insurers cannot create financial barriers or penalties for selecting a specific pharmacy. Additionally, the bill enhances pharmacy audit protections by limiting the frequency and scope of audits, requiring advance notice, and mandating detailed documentation for any recoupments. The bill defines key terms like "specialty drug" and "generic equivalent" and establishes reporting requirements for PBMs to increase transparency in prescription drug pricing. The provisions will become effective October 1, 2025, and apply to contracts issued, renewed, or amended on or after that date, giving stakeholders time to adjust to the new requirements.

Government Affairs, Health and Social Services

https://www.ncleg.gov/BillLookUp/2025/H163