AN ACT TO PROMOTE PRICING TRANSPARENCY FOR PATIENTS AND TO ESTABLISH STANDARDS AND CRITERIA FOR THE REGULATION AND LICENSURE OF PHARMACY BENEFITS MANAGERS PROVIDING SERVICES FOR HEALTH BENEFIT PLANS IN NORTH CAROLINA.
Senate committee substitute makes the following changes to the 1st edition.
Amends and adds to the proposed changes to Article 56A, Pharmacy Benefits Management, of GS Chapter 58 as follows.
Adds to the defined terms: 340B pharmacy and 340B covered entity. Changes the definition of the terms insurer and pharmacy to now define the terms by statutory cross-reference. Revises the definition of the newly defined term pharmacy benefits manager affiliate to no longer include a pharmacy or pharmacist that directly or indirectly is under the common ownership or control with a pharmacy benefits manager.
Revises the proposed new language in GS 58-56A-4 to bar a pharmacy benefits manager from prohibiting a licensed pharmacy or pharmacist from dispensing any prescription drug (was, prohibit or restrict in any way).
Modifies new GS 58-56A-15 to more specifically prohibit pharmacy benefits managers from denying licensed pharmacists or pharmacies from participating in a retail pharmacy network (was, a network) on the same terms and conditions of other similarly situated network participants (was, other network participants).
Enacts new GS 58-56A-50, establishing two limitations of contracts between a pharmacy benefits manager and a 340B covered entity's pharmacy or between a pharmacy benefits manager and a 340B contract pharmacy, including: (1) prohibiting restricting access to a pharmacy network or adjusting 340B drug reimbursement rates based on whether a pharmacy dispenses drugs under the 340B drug discount program; or (2) prohibiting assessing any additional, or varying the amount of any, fees, chargebacks, or other adjustments on the basis of a drug being dispensed under the 340B drug discount program or a pharmacy's status as a 340B covered entity or a 340B contract pharmacy (not including adjustments to correct errors or overpayments resulting from an adjudicated claim). Defines 340B covered entity as any entity defined in one of five specified federal law provisions, including a federally-qualified health center; a critical access hospital; or a rural referral center. Defines 340B contract pharmacy as any pharmacy under contract with a 340B covered entity to dispense drugs on behalf of the 340B covered entity. Prohibits pharmacy benefits managers making payments pursuant to a health benefit plan from discriminating against a 340B entity or a 340B contract pharmacy in a manner that prevents or interferes with an enrollee's choice to receive a prescription drug from an in-network 340B covered entity or an in-network 340B contract pharmacy. Deems the provisions regarding choice of pharmacy under GS 58-51-37 applicable to pharmacy benefits managers with respect to 340B covered entities and 340B contract pharmacies. Deems any contractual provisions contrary to the statute as unenforceable. Makes conforming changes to GS 58-51-37, adding a provision to explicitly include pharmacy benefits managers in the scope of the statute with respect to 340B covered entities and 340B contract pharmacies.
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