AN ACT TO AUTHORIZE SKATING RINKS, BOWLING ALLEYS, AND VENUES FOR RECEPTIONS OR PARTIES TO RESUME OPERATIONS AND TO AUTHORIZE OUTDOOR STADIUMS OPERATING RESTAURANTS TO OFFER AND OPERATE OUTDOOR DINING AND BEVERAGE SERVICE OPTIONS WHILE ALSO SAFEGUARDING THE PUBLIC HEALTH TO PREVENT THE SPREAD OF CORONAVIRUS DISEASE 2019 (COVID-19).
House committee substitute to the 3rd edition makes the following changes.
Changes the date by which the Department of Health and Human Services must review and revise its current Freestanding Birth Center Fee Schedule from October 1, 2019, to December 1, 2019.
Amends the proposed changes to the definition of the term health benefit plan in Article 56A, Pharmacy Management Benefits, of GS Chapter 58. Previously, the term was defined by statutory cross-reference to GS 58-3-167, which defines health benefit plan in the context of the applicability of acts of the General Assembly to health benefit plans. Instead, defines health benefit plan under Article 56A to mean an accident and health insurance policy or certificate; a nonprofit hospital or medical service corporation contract; a health maintenance organization subscriber contract; a plan provided by a multiple employer welfare arrangement; a plan provided by another benefit arrangement, to the extent permitted by the Employee Retirement Income Security Act of 1974, as amended, or by any waiver of or other exception to that act provided under federal law or regulation; or any plan implemented or administered by the State Health Plan for Teachers and State Employees (SHP). Excludes from the term any plan implemented or administered by the NC or US Department of Health and Human Services, or any successor agency, or its representatives, or any plan consisting of one or more of any combination of benefits described in GS 58-68-25(b) (similar to the term's definition set forth in GS 58-3-167, except the term is defined in GS 58-3-167 to exclude any plan implemented or administered by the SHP, which is included in the term's proposed definition in Article 56A, as amended).
Amends GS 58-56A-3 to require that when calculating an insured's contribution to an out-of-pocket maximum, deductible, copayment, coinsurance, or any other cost-sharing requirement, the insurer or PBM must include any cost-sharing amount paid by the insured or on the insured's behalf for a prescription drug that is (1) without an AB-rated generic equivalent or (2) with an AB-rated generic equivalent if the insured has obtained authorization for the drug through prior authorization from the insurer or PBM, a step therapy protocol, or the exception or appeal process of the insurer or PBM (was, when calculating an insured's overall contribution to any out-of-pocket maximum or any cost-sharing requirement under a health benefit plan, an insurer must include any amounts paid by the insured or paid on behalf of the insured by another person). Defines the term generic equivalent as a drug that has an identical amount of the same active ingredients in the same dosage form; meets applicable standards of strength, quality, and purity according to the specified compendium; and which, if administered in the same amount, would provide comparable therapeutic effects. Excludes from the definition a drug that is listed by the US Food and Drug Administration as having unresolved bioequivalence concerns according to the Administration's most recent publication of approved drug products with therapeutic equivalent evaluations.
Enacts new GS 58-3-222 prohibiting an insurer who offers coverage for prescription drugs from requiring any insured to take any drug with a boxed warning. Requires an insurer who offers coverage for prescription drugs and requires preauthorization as a condition to providing coverage for a drug to immediately provide coverage for the drug during the period of time it takes the insurer to conduct the preauthorization review. Specifies that this does not require an insurer to approve a drug undergoing a preauthorization review. Applies to insurance contracts issued, renewed, or amended on or after October 1, 2020.
Amends the act's long title.
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