House committee substitute to the 1st edition makes the following changes. 

Adds and defines the terms generic equivalent, high-deductible health plan, and Section 223 in GS 58-56A-1 (previously, the recodification and proposed changes to the term generic equivalent, from GS 58-56A-3(c2), appeared in a later section of the act, as well as the addition of the two other defined terms). Changes the proposed definition of national average drug acquisition cost to mean the publicly available, most current pharmacy acquisition cost benchmark published by the Centers for Medicare and Medical Services (CMS), which reflects the average price that retail community pharmacies pay to acquire prescription drugs from wholesalers, excluding rebates and discounts. Changes the proposed definition of specialty pharmacy accreditation to mean a certification granted by an independent, nationally recognized accrediting organization that evaluates a pharmacy's compliance with quality, safety, and service standards for handling, dispensing, and managing specialty medications. Adds that the accreditation can be issued by one of the three organizations identified in the previously proposed definition, and includes similar nationally recognized accrediting organizations.

Adds to the actions prohibited by a pharmacy benefits manager (Manager) under new GS 58-58A-6: (1) directly or indirectly redirecting any prescription drug claims submitted by a pharmacy or pharmacist to a third-party discount card program, cash discount program, or any other non-insurance adjudication platform; or (2) using Manager policy documents incorporated into a pharmacy agreement to materially change, alter, or modify the agreement; to modify, limit, or negate reimbursement rates, payment terms, or other financial obligations; or introduce material changes to the definitions of brand and generic drugs, claims adjudication, audit process, or contractual rights of the pharmacy or pharmacist. Includes a non-exhaustive list of materials that constitute Manager policy documents. Prohibits a Manager from prohibiting or penalizing a pharmacy or pharmacist dispensing pharmaceutical product from informing an individual about the cost of the product; the amount in reimbursement the pharmacy or pharmacist receives for dispensing the product; the cost and clinical efficacy of a less expensive alternative to the product; or any difference between the cost to the individual under the individual's pharmacy benefits plan or program and the cost to the individual if the individual purchases the product without making a claim for benefits under their plan or program. 

Moves the section of the act proposing new GS 58-56A-25(d), relating to audits of pharmacies and pharmacists conducted by a Manager, insurer, or third-party administrator.

Changes the effective date for the requirement of Managers to submit quarterly reports under new GS 58-56A-22 to May 1, 2026 (was April 1, 2026).

Adds to the proposed changes to GS 58-56A-3 to no longer require pharmacies or pharmacists to disclose, when charging a shipping and handling fee to the insured for a mailed or delivery prescription, that the charge is specifically agreed to by the health benefit plan or Manager. Repeals subsection (c2) defining "generic equivalent" under the section (previously, proposed recodification and changes to the definition, and added two other terms to GS 58-56A-1). Adds new subsection (c3) to provide for Managers' calculation of an insured's out-of-pocket cost for a covered prescription drug. Requires the Manager to base the calculation on the net price of the prescription drug after taking into account all concessions associated with that prescription drug that the Manager has or will receive. Bars using the current retail price if the Manager has received, is receiving, or will receive any concessions associated with that particular prescription drug. 

Changes the proposed changes to the rights of a pharmacy under GS 90-85.50 concerning audit restrictions. Now authorizes only one audit per calendar quarter of a retail pharmacy, and restricts the audit to the lesser of (1) 0.1% of the number of total prescription fills processed through the Manager for that retail pharmacy in a calendar year, or (2) 50 prescription fills processed through the Manager for that calendar year.

Specifies that the date the auditing pharmacy under GS 90-85.52 must include in its summary describing the total recoupment is the approximate date, within a seven-day window, on which the recoupment will be assessed (was, the date on which the recoupment will be assessed). 

Amends GS 58-3-167, governing the applicability of acts of the NCGA on health benefit plans, specifying that "health benefit plan" as used in the statute does not mean any self-funded plan implemented or administered by a local government.