Bill Summary for H 178 (2021-2022)
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View NCGA Bill Details | 2021 |
AN ACT TO REQUIRE ACCESS TO ACCURATE PRESCRIPTION DRUG BENEFIT COST INFORMATION.Intro. by Sasser, Adcock, Potts, K. Baker.
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Bill summary
Enacts new Article 56B, Access to Prescription Drug Benefit Cost Information, in GS Chapter 58. Sets out and defines terms used in the Article. Sets out NCGA findings of facts related to prescription drug cost transparency, driving full value of health benefit plan formularies and understanding coverage and payment considerations for drugs and the opportunity to benefit from competitive prescription drug pricing. Requires health benefit plans, pharmacy benefits managers, or any entities' action on behalf of a health benefit plan to electronically provide to any point of prescribing of a prescription drug, any point of dispensing of a prescription drug, or any patient-facing real-time benefit tool, the minimum information described to inform patient prescription price transparency and patients' access to their prescribed medications. Requires those involved in the process of prescribing, dispensing, paying for, and exchanging information relating to prescription drugs, to take any actions necessary to facilitate the creation of, access to, and use of this technology described. Specifies that patient prescription price transparency technology must not be prohibited from displaying patient financial and resource assistance when that information is available for the prescription drug selected by a provider.
Requires requests for patient-specific drug benefit and cost information through the technology required above and any responses using that technology to be sent and received in real time. Requires electronic health records to display the most up-to-date patient-specific eligibility information; patient-specific information must be provided in real time. Requires those involved in the process of prescribing, dispensing, paying for, and exchanging information relating to prescription drugs to partner with intermediaries to ensure the delivery of accurate patient-specific prescription price transparency information.
Provides that the Article does not interfere with patient choice and a health care professional's ability to convey the full range of prescription drug cost options to a patient. Prohibits restricting a health care professional from communicating prescription cost options to a patient. Specifies that payors must not prohibit the display of patient-specific prescription drug benefit and cost information at the point of prescribing that reflects options available for covering the cost of a prescription drug other than what may be available under the patient's health benefit plan. Requires providers to communicate to a patient the most therapeutically appropriate treatment for the patient's diagnosis and prescription drug cost information.
Specifies that the Article is not to be construed to interfere with a patient's choice of prescription drug cost coverage or to interfere with patient choice and the ability of a health care professional to convey the full range of prescription drug cost options to a patient. Prohibits restricting a health care professional from communicating prescription cost options to a patient.
Effective July 1, 2021.