Section 1.

Broadens the scope of GS 58-51-37 (concerning pharmacy of choice) by: (1) removing the exemptions for those entities that have its own facility, employs or contracts with physicians, pharmacists, nurses, and other health care personnel, and that dispenses prescription drugs from its own pharmacy to its employees and to enrollees of its health benefit plan and (2) removing limitation that health benefit plans providing pharmacy services must be providing those services to State residents for the statute to apply.

Adds seven new defined terms, including insured (any individual covered by a health benefit plan), pharmacy desert (either an urban community or neighborhood without a pharmacy within a one-mile radius of any point in the community or neighborhood or a rural community without a pharmacy within a ten-mile radius of any point in the community). Amends defined terms health benefit plan and insurer.  

Excludes those monetary advantages imposed upon a pharmacy located in a pharmacy desert or a county with a population of fewer than 5,000 residents from prohibited monetary advantage practices. Now also prevents an insurer from requiring an insured to purchase pharmacy products as a condition of payment or reimbursement (currently, insurer is only limited from requiring an insured to purchase pharmacy services).

Removes provisions subjecting any insurer or entity providing a health benefit plan to GS 58-2-70 (civil penalties or restitution for violations of GS Chapter 58). Makes clarifying, technical, and organizational changes. Effective October 1, 2025, and applies to insurance contracts entered into or amended on that date.

Section 2.

Enacts Article 56B, “Pharmacy Services Administrative Organizations (PSAO’s)” to GS Chapter 58. Defines eight terms, including pharmacy benefits manager or PBM. Prevents, in GS 58-56B-5 a PSAO that negotiates with PBMs, third-party payers, or both on behalf of any pharmacy in this State from operating without obtaining a license from the Department of Insurance (DOI). Provides for an application with an initial $200 application fee and an annual renewal fee of $150. Provides for notice if a PSAO has to materially modify any of the application information. Specifies that information contained in a report that a PSAO is required to submit to DOI is not a public record. Requires redacting of personal information in any report or disclosure a PSAO is required to submit to DOI. Requires a PSAO to disclose its ownership as described to both DOI and to any independent pharmacy, PBM, or third-party payer prior to entering into a contract with that entity, in GS 58-56B-10. Prevents in GS 58-56B-30 a PSAO that owns or is owned by–in whole or in part--any entity that manufactures, sells, or distributes prescription drugs, biological products, or medical devices from, as a condition of entering into a PSAO-pharmacy contract, require that the independent  pharmacy purchase any drugs or medical devices solely from an entity with which the PSAO has  an ownership interest or that has an ownership in the PSAO. Requires those PSAOs to disclose to DOI any agreement with an independent pharmacy to purchase prescription drugs, biological products, or medical devices by an independent pharmacy from the PSAO or an entity with which the PSAO has an ownership interest or that has an ownership in the PSAO.

Details required terms of a PSAO-pharmacy contract in GS 58-56B-15 including a requirement that the PSAO not require a pharmacy to purchase specific amounts of prescription drugs, whether generic or brand name, to access discounts. Prevents a PSAO from discriminating on the price of drugs sold to an independent pharmacy based on the price of drugs purchased from a wholesale distributor of the drug in GS 58-56B-20. Directs any PSAO that provides, accepts, or possesses a discount, concession, or product voucher in order to reduce, directly or indirectly, a beneficiary's or insured's out-of-pocket expense for the order, dispensing, substitution, sale, or purchase of a prescription drug to provide an annual report to DOI that includes (1) the aggregated total of all transactions for which the PSAO provided, accepted, or possessed a discount, concession, or product voucher by an independent pharmacy and (2) the aggregated total of any payments received by the PSAO itself providing, accepting, or possessing a discount, concession, or product voucher on behalf of an independent pharmacy. Provides for an appeals process if there is a dispute between an independent pharmacy and a PBM or third-party payer, in GS 58-56B-35, as described. Sets forth financial penalties of $1,000 per day, potential suspension or revocation of licensure, and civil and administrative unfair trade practice remedies for violations of the Article in GS 58-56B-40. Authorizes the Commissioner of Insurance (Commissioner) to adopt rules, both permanent and temporary, to administer the Article. Effective October 1, 2026, and applies to contracts entered into, renewed, or amended on or after that date.

Section 3.

Enacts GS 58-56A-22, requiring all PBM’s to submit an annual report to the Commissioner by March 1 of each year on the specified information regarding prescription drug benefits specific to insurers within the State with which a pharmacy benefits manager has a contract. Provides for aggregate reports prepared by PMB’s to contracted insurers upon request that discloses the total amount of the difference between the amount paid by each contracted health benefit plan offered by the insurer for prescription drugs and the aggregated amount paid to pharmacies for claims paid under each applicable health benefit plan. Requires all reports prepared under GS 58-56A-22 from revealing personally identifiable information. Specifies that these reports are not public records and are considered confidential and privileged.

Expands the protections under GS 58-56A-4 by preventing a PBM contract from requiring, either directly or indirectly, or through a pharmacy services administration organization, a pharmacy or pharmacist to accept reimbursement for providing a covered prescription drug, device, or service at a rate that is less than the acquisition cost for the covered drug, device, or service. Specifies that a violation of GS 58-56A-4 is an unfair trade practice under Article 63 of GS Chapter 58 and under GS 75-1.1 and is subject to all the enforcement and penalty provisions of an unfair trade practice under GS Chapter 58 and under Article 1 of GS Chapter 75. Applies to contracts entered into, renewed, or amended on or after October 1, 2025.

Specifies that any pharmacy or pharmacist who has a contract, either directly or through a PSAO, with a PBM administering any type of drug or pharmacy benefit plan to provide covered drugs, devices, or services at a contractual reimbursement rate may decline to provide a covered drug, device, or service if the pharmacy or pharmacist will be or is paid less than the acquisition cost for the covered drug, device, or service. Instructs that act of declining to provide a covered drug, device, or service as authorized by this subsection cannot be construed to be a violation under the NC Pharmacy Practice Act (GS 90-85-40). Applies to prescription drugs, devices, or services provided by a pharmacy or pharmacist on or after October 1, 2025.

Applies all requirements relating to coverage of prescription drugs and pharmacy services under GS Chapter 58 governing health benefit plans to PBM’s as well as insurers. Applies Article 63 of GS Chapter 58, covering unfair trade practices, to PHB’s in the same manner as it applies to an insurer.

Establishes in GS 58-56A-21, that a PBM has a fiduciary duty to act in good faith and fair dealing in the performance of its contractual duties, including (1) controlling costs, (2) acting in the insureds’ best interests, (3) acting with prudence and passing through any rebates or discounts the PBM received related to covered benefits bought and paid for with the contracted insurer's assets or fund, and (4) avoiding self-dealing and conflicts of interest. Makes technical and conforming changes, including to the statute's title.

Section 4.

Applies GS 58-51-37 (discussed in Section 1, above) to PHB’s that contract with an insurer in GS 58-56A-3 (consumer protections related to PHB’s). Requires in GS 58-56A-15 (PHB networks), for a PHB network to meet or exceed the Medicare Part D program standards for convenient access to network pharmacies under federal law. Applies to all contracts entered into, renewed, or amended on or after October 1, 2025.

Section 5.

Adds independent pharmacy to the defined terms of the NC Pharmacy Practice Act. Expands the practice of pharmacy provisions of GS 90-85.3 so that a pharmacy has a professional responsibility to offer complete pharmaceutical services to meet patient needs. Enacts GS 90-85.21E that allows an independent pharmacy to decline or refill a prescription if the act would directly result in an unbearable cost to the independent pharmacy so long as it refers the patient to another equally convenient pharmacy as described. Allows referral to a pharmacy that only provides centralized pharmacy services in this State through the mail or remote medication order processing services subject to the NC Board of Pharmacy (Pharmacy Board)’s rules if the independent pharmacy determines the provision of pharmaceutical services through the mail does not harm the patient. If the independent pharmacy cannot find a pharmacy to accept the referral without causing harm to the patient, then the independent pharmacy must fill the prescription. Directs the Pharmacy Board to adopt rules to implement the act. Effective October 1, 2025.

Section 6.

Recodifies Article 4C (Pharmacy Audit Rights) of GS Chapter 90 to Part 8 of Article 50 of GS Chapter 58 with the twelve described reorganizations. Amends new Part 8 as created by the act, as follows. Adds terms auditing entity (a responsible party conducting an audit of a pharmacy or the entity conducting an audit of a pharmacy on behalf of a responsible party) and medication error to the definitions provision of new Part 8. Modifies the term responsible party so that it now means an insurer offering a health benefit plan or other entity regulated under GS Chapter 58 responsible for claims payments for healthcare services. Expands the term pharmacy so it includes individuals holding a valid pharmacy permit. Makes technical and conforming changes. Modifies the scope of GS 58-50-405 (rights of a pharmacy pertaining to audits) so that it applies when an auditing entity (was, when a managed care company, insurance company, third party payer, or any entity representing a responsible party) conducts an audit of the records of a pharmacy. Makes technical, clarifying, and conforming changes.

Makes technical, clarifying, and conforming changes to GS 58-50-410 (pharmacy audit requirements). Specifies that an auditing entity cannot subject a pharmacy to recoupments that contain a requirement that a pharmacy or pharmacist perform a professional duty in addition to or that exceeds those required under NC Pharmacy Practice Act, in addition to Pharmacy Board. Makes technical and conforming changes to GS 58-50-415 (reversals of approval), GS 58-50-420 (mandatory appeals process), and GS 58-50-425(applicability). Authorizes the Commissioner to adopt rules to implement, administer, and enforce new Part 8.

Effective January 1, 2026, makes the following changes to new Part 8 as amended by the act. Modifies GS 58-50-405 (pharmacy rights during an audit) as follows:

• Lowers number of total prescriptions to be audited in an audit conducted for a reason other than an identified problem from 100 selected prescriptions to 25 prescriptions, including refills.
• Specifies that the pharmacy is entitled to written notice provided at least 14 days prior to any audit of additional claims that details the basis for the review of additional claims, including a specific description of any suspected fraud or abuse.

Prior to recoupment, requires an auditing entity to provide the pharmacy with a summary describing the total recoupment amount and the date on which the recoupment will occur, as specified, in GS 58-50-410. Enacts GS 58-50-429 (violations) specifying that a violation of Part 8 is unfair trade practice under both Article 63 of GS Chapter 58 and GS 75-1.1 and is subject to all of the enforcement and penalty provisions of an unfair trade practice under Article 1 of GS Chapter 75.

Applies to audits conducted on or after January 1, 2026.

Section 7.

Prevents a PBM from reimbursing a pharmacy or pharmacist an amount less than the amount that the PBM reimburses a pharmacy benefits manager affiliate for providing the same pharmacist services or same prescription drug in GS 58-56A-20. Sets forth calculation for determining reimbursement amount. Specifies that violations are an unfair trade practice under both Article 63 of GS Chapter 58 and GS 75-1.1 and subject to all of the enforcement and penalty provisions of an unfair trade practice under Article 1 of GS Chapter 75. Applies to pharmacist services or prescription drugs dispensed on or after October 1, 2025.

Section 8.

Enacts GS 58-3-182 (concerning consumer protections and prescription cost sharing). Defines four terms including defined cost-sharing (a deductible payment or coinsurance amount imposed on an insured for a prescription drug covered under the insured’s health benefit plan). When calculating an insured's defined cost-sharing for a covered prescription drug at the point of sale, directs the insurer to base the calculation on the price of the prescription drug after considering all pharmacy rebates associated with that prescription drug. Requires the price of the prescription drug and any defined cost-sharing to be reduced by an amount equal to 90% of all pharmacy rebates received, or to be received, in conjunction with the dispensing or administration of the prescription drug. Clarifies that GS 58-3-182 does not preclude an insurer from decreasing an insured's defined cost-sharing by an amount greater than that required under the section. Provides for an annual certification of compliance by the insurer to the Commissioner. Directs that failure to complete the certification or comply with any of the other requirements under GS 58-3-182 is a violation subject to GS 58-2-70 (civil penalties or restitution for violations of GS Chapter 58). Each day that an insurer fails to complete the certification is considered a separate violation. Applies GS 58-3-182 to PBM’s when calculating an insured's out-of-pocket cost for a covered prescription drug. Applies to prescription drugs purchased on or after October 1, 2025.

Section 9.

Enacts Article 4D, Prescription Drug Transparency, to GS Chapter 90, as follows. Defines six terms. Requires in GS 90-85.56 for a manufacturer (defined) to annually notify all interested parties of the 20 highest drug price increases imposed by the manufacturer during that year. No later than January 31, requires the manufacturer to disclose the following to interested parties for each drug price increase noticed: (1) the date and price of acquisition of the drug, if it was not developed by the manufacturer and (2) a schedule of price increases for the drug for the five years prior to the calendar year for which the drug price increase was required to be noticed under GS 90-85.56. Requires a manufacturer to notify all interested parties of the price of any new prescription drug within three days after the manufacturer receives approval by the FDA, and within 30 days after the notice to disclose to interested parties the date and price of acquisition of the drug if it was not developed by the manufacturer. Requires the Secretary of the Department of Health and Human Services (Secretary) in GS 90-85.57, to assess a civil penalty against a manufacturer that fails to report the information required by Article 4D, not to exceed $1,000 for each day the manufacturer fails to submit the required information. Directs the clear proceeds of those penalties be remitted to the Civil Penalty and Forfeiture Fund (Fund). Applies the APA to proceedings for the assessment of civil penalties.  Requires the Secretary to develop a data collection plan for data from manufacturers related to the cost and pricing of prescription drugs to provide transparency and accountability for prescription drug pricing. Requires the Secretary to submit the plan as the first part of an annual report to be submitted to the specified NCGA committee, starting March 1, 2026, to also include information on prescription drugs sold in the State. Requires the Secretary to create an online portal to provide the public with access to the information required by Article 4D.