Bill Summaries: S257 MEDICATION COST TRANSPARENCY ACT.

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  • Summary date: Sep 20 2021 - More information

    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. SL 2021-161. Enacted Sept. 20, 2021. Effective Oct. 1, 2021.


  • Summary date: Sep 8 2021 - More information

    Conference report makes the following changes to the 5th edition. 

    Replaces the definition given to the new defined term 340B covered entity, applicable to Article 56A, Pharmacy Benefits Management, of GS Chapter 58. Now more specifically defines the term to mean any entity defined in one of nine identified sub-subdivisions of 42 USC 256b(a)(4), rather than any entity defined in that subdivision. Defines pharmacy by statutory cross-reference rather than as a pharmacy registered with the NC Board of Pharmacy. Limits the term pharmacy benefits manager affiliate to no longer include a pharmacy or pharmacist that is under common ownership or control with a pharmacy benefits manager. Renames the defined term pharmacy services administration organization as pharmacy service administrative organization (PSAO), and makes conforming changes throughout to reflect the change. No longer includes biosimilar or other prescription drug or device services in the Article's defined terms. Makes technical changes. 

    Maintains rather than amends existing law regarding consumer protections set forth in subsections (a) and (b) of GS 58-56A-3, which prohibit (1) pharmacies and pharmacists from penalizing (previously, expanded to include prohibiting, restricting, or penalizing) pharmacy benefits managers from discussing the insured's cost share of prescription drugs, or selling a lower-priced drug to the insured, and (2) pharmacy benefits manager from contracting to prohibit (was, to prohibit or restrict) a pharmacy from offering and providing direct and limited delivery services to an insured as an ancillary service of the pharmacy, as set forth in the contract between the pharmacy benefits manager and the pharmacy. Revises the remaining provisions as follows. Eliminates the five additional prohibitions of pharmacy benefits managers contracting with pharmacies previously added to subsection (b), including contracting to prohibit or restrict the pharmacy from disclosing to any insured any health care information that the pharmacy or pharmacist determines is appropriate so long as it is within the pharmacist's scope of practice, or discussing information relating to the total costs for pharmacist services for a prescription drug. Eliminates the proposed provision which prohibited a pharmacy benefits manager from penalizing or retaliating against a pharmacy for any activities described in subsection (b). Now requires the pharmacy or pharmacist to disclose that a shipping and handling fee for mailed or delivered prescriptions is agreed to by the health benefit plan or pharmacy benefits manager. Now prohibits the pharmacy benefits manager from charging or attempting to collect from an insured a copayment that exceeds the total submitted charged by the network pharmacy (was, prohibited from charging or attempting to collect a copayment that exceeds the lesser of (1) the total submitted charges by the network pharmacy; (2) the contracted copayment amount; or (3) the amount an individual would pay for a prescription drug if that individual was not insured and was paying cash for the prescription drug). Replaces proposed new subsection (c1), which added a new requirement for an insurer to include any amounts paid by the insured or paid on behalf of the insured by another person when calculating an insured's overall contribution to any out-of-pocket maximum or any cost-sharing requirement under a health benefit plan, to the extent allowed under state and federal law. Instead, requires the insurer or pharmacy benefits manager to include in the calculation of any out-of-pocket maximum, deductible, copayment, coinsurance, or other applicable cost-sharing requirement, any amounts paid by the insured or on the insured's behalf for a prescription that is either without an AB-rated generic equivalent, or with an AB-rated generic equivalent and the insured has obtained authorization for the drug through one of three methods. Defines generic equivalent; excludes a drug listed by the FDA as having unresolved bioequivalence concerns as specified. Eliminates the provisions of proposed subsections (f) through (i), which: prohibited a pharmacy benefits manager from causing or knowingly permitting the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading, knowingly making any misrepresentation, or requiring an insured to use a pharmacy benefits manager affiliate for the filling of a prescription or the provision of any pharmacy care services; provided that an insured cannot be restricted from using any in-network pharmacy or pharmacist for any prescription drug covered by the health benefit plan or pharmacy benefits manager applicable; prohibited a pharmacy benefits manager from contracting to prohibit a pharmacy from discussing information relating to the total cost for pharmacist services for a prescription drug, or from selling a more affordable alternative to the insured if a more affordable alternative is available; and barred a pharmacy benefits manager from prohibiting a pharmacy or pharmacist from sharing proprietary or confidential information. 

    Makes the following modifications regarding pharmacy and pharmacist protections, set out in GS 58-56A-4. Prohibits charging fees or adjustments for the receipt and processing of a claim or its adjudication without a justification on the remittance advice or as set out in contract and agreed upon by the pharmacy or pharmacist for each adjustment or fee (previously, limited to justification on the remittance advice only). Maintains existing law which exempts from the application of the protections provided for pharmacies and pharmacists, claims under an employee benefits plan under the Employee Retirement Income Security Act of 1974 (previously, qualified the explicit application of the protections under such plans to the extent such application is allowed under federal law). Further specifies that a pharmacy or pharmacist cannot be prohibited by a pharmacy benefits manager from dispensing any prescription drug allowed under licensure, including dispensing specialty drugs dispensed by a credentialed and accredited pharmacy (previously, removed the specification of specialty drugs dispensed by a credentialed and accredited pharmacy). Reinstates the previously proposed provision including a pharmacy or pharmacist's agreement to an adjustment in situations that warrant retroactive denial or reduction of a claim for pharmacist services after adjudication of the claim. Eliminates previously proposed subsection (g) and (h), which: prohibited a pharmacy benefits manager from engaging in the pattern or practice of reimbursing independent pharmacies and pharmacists in the state consistently less than the amount of the National Drug Average Acquisition Cost (NDAAC) or the amount that the pharmacy benefits manager reimburses a pharmacy benefits affiliate for providing the same pharmacist services; and barred pharmacy benefits managers from requiring the use of mail order or a pharmacy benefits manager affiliate for filling prescriptions. 

    Eliminates proposed new subsections (b1) and (e) of GS 58-56A-5, which: required a pharmacy benefits manager to update its maximum allowable cost list for a prescription drug within five calendar days and provide notice to contracted pharmacies within 72 business hours of the update if any of three described circumstances exist; and barred a pharmacy benefits manager from engaging in a pattern or practice of reimbursing independent pharmacies or pharmacists consistently less than the amount of the NDAAC, the Wholesale Acquisition Cost when the NDAAC is not available, or an amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for providing the same pharmacist services. 

    Eliminates proposed GS 58-56A-6, which required a health benefit plan or pharmacy benefits manager that authorizes coverage for a biosimilar of a prescription medication to authorize coverage for all biosimilars of that prescription medication with coverage at the same level, and prohibited a health benefit plan or pharmacy benefits manager from requiring the use or the dispensing of a reference product over a biosimilar. 

    Eliminates GS 58-56A-10, which prohibited pharmacy benefits managers or insurers from requiring any prescription medication to be obtained from an entity operating as an intermediary to have prescription medications administered or delivered to a patient or another pharmacy, hospital, clinic, or provider unless that entity is a pharmacy operating as an intermediary and meets five criteria. 

    Replaces the provisions governing pharmacy benefits manager networks set out in proposed GS 58-56A-15 with the following. Now prohibits pharmacy benefits managers from denying properly licensed pharmacists or pharmacies from participating in a retail pharmacy network on the same terms and conditions of other similarly situated network participants. Entitles pharmacists or pharmacies that are members of a PSAO that contracts with a health benefit plan issuer or pharmacy benefits manager on the pharmacy's behalf to receive from the PSAO a copy of the contract provisions application to the pharmacy, including the pharmacy's rights and obligations under the contract. Provides for continued liability for payment due for services rendered following termination of a pharmacist or pharmacy from a pharmacy benefits manager network, excluding cases of fraud, waste and abuse. 

    Eliminates the proposed new provisions regarding penalties for violations of the Article as follows, no longer requiring the Commissioner of Insurance to consider specified factors in determining the amount of a civil penalty for a violation of the Article (other than violations GS 58-56A-5, which governs the maximum allowable cost price of prescription drugs).

    Adds a new directive requiring the Department of Insurance to convene a stakeholder workgroup by December 1, 2021, to study and recommend a single, unified process to accredit specialty pharmacies in the State. States required membership of the workgroup and requires the workgroup to meet at least three times. Charges the workgroup with examining the regulatory, administrative, and financial challenges facing those who wish to gain specialty pharmacy status. Requires the workgroup to report to the specified NCGA committees by May 15, 2022. 


  • Summary date: Aug 18 2021 - More information

    House amendment makes the following changes to the 4th edition. 

    Replaces the definition given to the new defined term 340B covered entity, applicable to Article 56A, Pharmacy Benefits Management, of GS Chapter 58. Now defines the term to mean any entity defined in 42 USC 256b(a)(4), rather than any entity defined in nine specific sub-subdivisions of that subdivision. 


  • Summary date: Aug 18 2021 - More information

    House committee substitute makes the following changes to the 3rd 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: biosimilar and other prescription drug or device services. No longer includes a statutory cross-reference to define pharmacy. Now defines pharmacy services administration organization as an organization that assists community pharmacists and pharmacy benefits managers or third-party payors in achieving administrative efficiencies, including contracting and payment efficiencies. Expands the term pharmacy benefits manager affiliate to include a pharmacy or pharmacist that is under common ownership or control with a pharmacy benefits manager. Makes additional clarifying and technical changes.

    Adds a new provision to direct the Commissioner of Insurance to adopt rules establishing the licensing and reporting requirements of pharmacy benefits managers consistent with the Article. 

    Expands the Article's provisions regarding consumer protections to prohibit pharmacies and pharmacists from prohibiting, restricting, or penalizing (previously, prohibited penalizing only) pharmacy benefits managers from discussing the insured's cost share of prescription drugs, or selling a lower-priced drug to the insured. Additionally, now prohibits a pharmacy benefits manager from contracting to prohibit or restrict a pharmacy from taking six actions, including (1) offering and providing direct and limited delivery services to an insured as an ancillary service of the pharmacy, (2) disclosing to any insured any health care information that the pharmacy or pharmacist determines is appropriate so long as it is within the pharmacist's scope of practice, (3) discussing information relating to the total costs for pharmacist services for a prescription drug, and (4) selling a more affordable alternative of the prescription drug to the insured if available. Adds a new restriction to prohibit a pharmacy benefits manager from penalizing or retaliating against a pharmacy for any of these six activities. No longer requires the pharmacy or pharmacist to disclose that a shipping and handling fee for mailed or delivered prescriptions is agreed to by the health benefit plan or pharmacy benefits manager. Now prohibits the pharmacy benefits manager from charging or attempting to collect from an insured a copayment that exceeds the lesser of (1) the total submitted charges by the network pharmacy; (2) the contracted copayment amount; or (3) the amount an individual would pay for a prescription drug if that individual was not insured and was paying cash for the prescription drug (was, prohibited from charging or attempting to collect a copayment that exceeds the total submitted charged by the network pharmacy). Adds the following new requirements and restrictions. Adds a new requirement for an insurer to include any amounts paid by the insured or paid on behalf of the insured by another person when calculating an insured's overall contribution to any out-of-pocket maximum or any cost-sharing requirement under a health benefit plan, to the extent allowed under state and federal law. Prohibits a pharmacy benefits manager from causing or knowingly permitting the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading; knowingly making any misrepresentation; or requiring an insured to use a pharmacy benefits manager affiliate for the filling of a prescription or the provision of any pharmacy care services. Provides that an insured cannot be restricted from using any in-network pharmacy or pharmacist for any prescription drug covered by the health benefit plan or pharmacy benefits manager applicable. Prohibits a pharmacy benefits manager from contracting to prohibit a pharmacy from discussing information relating to the total cost for pharmacist services for a prescription drug, or from selling a more affordable alternative to the insured if a more affordable alternative is available. Lastly, bars a pharmacy benefits manager from prohibiting a pharmacy or pharmacist from sharing proprietary or confidential information. 

    Makes the following modifications regarding pharmacy and pharmacist protections. Prohibits charging fees or adjustments for the receipt and processing of a claim or its adjudication without a justification on the remittance advice (was, or as set out in contract and agreed upon by the pharmacy or pharmacist for each adjustment or fee). Qualifies the explicit application of the protections provided for pharmacies and pharmacists to claims under an employee benefits plan under the Employee Retirement Income Security Act of 1974 to the extent such application is allowed under federal law. Further specifies that a pharmacy or pharmacist cannot be restricted in any way by a pharmacy benefits manager from dispensing any prescription drug allowed under licensure, including dispensing specialty drugs (no longer specifying specialty drugs dispensed by a credentialed and accredited pharmacy). No longer includes the pharmacy or pharmacist's agreement to an adjustment in situations that warrant retroactive denial or reduction of a claim for pharmacist services after adjudication of the claim. Adds the following. Prohibits a pharmacy benefits manager from engaging in the pattern or practice of reimbursing independent pharmacies and pharmacists in the state consistently less than the amount of the National Drug Average Acquisition Cost (NDAAC) or the amount that the pharmacy benefits manager reimburses a pharmacy benefits affiliate for providing the same pharmacist services. Bars pharmacy benefits managers from requiring the use of mail order or a pharmacy benefits manager affiliate for filling prescriptions. 

    Adds the following requirements regarding the maximum allowable cost price for prescription drugs. Requires a pharmacy benefits manager to update its maximum allowable cost list for a prescription drug within five calendar days and provide notice to contracted pharmacies within 72 business hours of the update if any of three described circumstances exist, including when (1) at least 60% of the pharmaceutical wholesalers doing business in the state have increased by 10% or more the pharmacy acquisition cost for the drug or (2) there is a change in the method on which the maximum allowable cost is based. Additionally bars a pharmacy benefits manager from engaging in a pattern or practice of reimbursing independent pharmacies or pharmacists consistently less than the amount of the NDAAC, the Wholesale Acquisition Cost when the NDAAC is not available, or an amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for providing the same pharmacist services. 

    Adds a new statute to the Article. Requires a health benefit plan or pharmacy benefits manager that authorizes coverage for a biosimilar, as defined, of a prescription medication to authorize coverage for all biosimilars of that prescription medication with coverage at the same level. Prohibits a health benefit plan or pharmacy benefits manager from requiring the use or the dispensing of a reference product over a biosimilar. 

    Adds a new statute to the Article prohibiting pharmacy benefits managers or insurers from requiring any prescription medication to be obtained from an entity operating as an intermediary to have prescription medications administered or delivered to a patient or another pharmacy, hospital, clinic, or provider unless that entity is a pharmacy operating as an intermediary and meets five criteria, including (1) having a mutual agreement between the patient, the intermediary, and the other pharmacy, hospital, clinic, or provider to use the process for the receipt, repackaging, administration, or delivery of the prescription medication; (2) having the distribution of prescription medications from the intermediary be in full and actual charge of a licensed pharmacist; and (3) having the pharmacy, hospital, clinic, or provider and the intermediary in compliance with all relevant rules adopted by the NC Board of Pharmacy. 

    Now prohibits pharmacy benefits managers from changing the network of pharmacies available to an insured without the insured or the insurer's written consent. Bars pharmacy benefits managers from creating separate pharmacy networks under a specific health benefit plan. Prohibits a pharmacy benefits manager from conditioning participation in a pharmacy benefits manager network upon accreditation standards or recertification requirements inconsistent with, more stringent than, or in addition to federal and State licensure requirements. Previously, entitled a pharmacist or pharmacy that is a member of a pharmacy service administration organization that enters into a contract with a health benefit plan issuer or a pharmacy benefits manager on the pharmacy's behalf to receive from the pharmacy service administration organization a copy of the contract provisions applicable to the pharmacy, including each provision relating to the pharmacy's rights and obligations under the contract. Replaces the provision, now requiring a pharmacist or pharmacy that belongs to a pharmacy service administration organization to receive a copy of the contract the pharmacy service administration organization entered into with a pharmacy benefits manager on the pharmacy's or pharmacist's behalf, upon request only. Regarding the continued obligation of payments due to pharmacies or pharmacists upon termination from the pharmacy benefits manager network, no longer excludes cases of fraud, waste, and abuse. 

    Adds a new statute to the Article requiring a pharmacy benefits manager to provide an insurer offering a health benefit plan that contracts with a pharmacy benefits manager the claims data that reflects the total amount the insurer paid to the pharmacy benefits manager under the plan for a specified outpatient prescription drug, including the ingredient cost and the dispensing fee, upon request. Requires providing the cost paid for the specified outpatient prescription drug, including the ingredient cost and the dispensing fee. 

    Adds to the provisions regarding penalties for violations of the Article as follows. Requires the Commissioner to consider the following in determining the amount of a civil penalty for a violation of the Article (other than GS 58-56A-5, which governs the maximum allowable cost price of prescription drugs): the degree and extent of harm caused by the violation; the amount of money that inured to the benefit of the violator as a result of the violation; whether the violation was willful; and the prior record of the violator in complying with laws, rules, or orders applicable to the violator. Adds further guidance and clarifications applicable to civil penalties imposed under the Article. 

    Makes further technical changes. 


  • Summary date: Jun 1 2021 - More information

    Senate amendment amends the second edition of the bill by expanding the definition of “covered entity” to include entities defined under 42 U.S.C. §256b(a)(4)(C), 42 U.S.C. §256b(a)(4)(I), 42 U.S.C. §256b(a)(4)(J), and 42 U.S.C. §256b(a)(4)(K).


  • Summary date: May 20 2021 - More information

    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. 


  • Summary date: Mar 15 2021 - More information

    Recodifies GS 58-56A-10 as GS 58-56A-30, which provides for civil penalties and procedure for violations of Article 56A, Pharmacy Benefits Management, of GS Chapter 58. Amends and adds to the Article as follows.

    Adds the following defined terms: claim, claims processing service, maximum allowable cost list, out-of-pocket costs, pharmacy services administration organization (PSAO) pharmacist services, and pharmacy benefits manager affiliate. Amends existing defined terms as follows. More specifically defines pharmacy benefits manager, which is currently defined to mean an entity who contracts with a pharmacy on behalf of an insurer or third-party administrator to administer or manage prescription drug benefits, to specify three functions the entity can perform under the definition: (1) negotiating rebates with manufacturers for drugs paid for or procured as described in the Article; (2) processing claims for prescription drugs or medical supplies or providing retail network management for pharmacies or pharmacists; or (3) paying pharmacies or pharmacists for prescription drugs or medical supplies. Changes the statutory cross-reference used to define health benefit plan, and no longer explicitly excludes the State Health Plan for Teachers and State Employees from the term. Amends the term maximum allowable cost price to define the term to mean the maximum amount that a pharmacy benefits manager will reimburse a pharmacy for the cost of generic or multiple source prescription drugs, medical products, or devices (previously the max per unit reimbursement for multiple source prescription drugs, medical products, or devices). 

    Prohibits persons or organizations from establishing or operating as a pharmacy benefits manager for health benefit plans in the State without being licensed. Charges the Commissioner of Insurance (Commissioner) with licensing responsibilities. Authorizes the Commissioner to set the initial application fee at $2,000 and the annual renewal fee at $1,500. Delineates required application content. Requires applicants or licensees to file notice of material changes to required information.

    Bars pharmacy benefit managers from prohibiting a pharmacist or pharmacy from charging a minimal shipping and handling fee for a mailed or delivered prescription if three disclosures are made to the insured by the pharmacist or pharmacy before delivery, including that the fee cannot be reimbursed by the health benefit plan, insurer, or pharmacy benefits manager.

    Requires any fee or adjustment charged for the receipt and processing of a claim or the adjudication of a claim be justified on the remittance advice or be set out in contract and agreed upon by the pharmacy or pharmacist for each adjustment or fee. Specifies that the Article does not abridge the right of a pharmacist to refuse to fill or refill a prescription if the pharmacist believes it would be harmful to the patient or is not in the patient's best interest, or if there is no question to the validity of the prescription. Prohibits a pharmacy benefits manager from restricting a licensed pharmacy or pharmacist from dispensing any prescription drug. Bars retaliation against pharmacists or pharmacies exercising rights granted by the Article. Establishes five grounds for retroactive denial or reduction of a claim for pharmacist services after adjudication of the claim, including that the original claim was submitted fraudulently or the adjustments were part of an attempt to limit overpayment recovery efforts by a pharmacy benefits manager. Provides that the statute does not limit overpayment recovery efforts.

    Adds a new provision to require pharmacy benefits managers to ensure that dispensing fees are not included in the calculation of a prescription drug's maximum allowable cost price. Additionally requires pharmacy benefits managers to create an administrative appeals procedure for contracted pharmacies or pharmacists, or their designee, to appeal the provider's reimbursement for a prescription drug subject to maximum allowable cost pricing. Restricts appeals to when the reimbursement amount for the drug is less than the net amount that the network provider paid to the drug supplier. Sets forth six requirements of the appeals procedure, including setting up a dedicated number and email address or website to submit appeals, allowing for at least 10 calendar days after the fill date to file an appeal and requiring a decision to be made within 10 days after receipt, and, for denied appeals, to require notification to include the names of the national or regional pharmaceutical wholesalers operating in the State.

    Enacts new provisions as follows. Prohibits pharmacy benefits managers from denying licensed pharmacists or pharmacies from participating in a network on the same terms and conditions of other network participants. Entitles pharmacists or pharmacies that are members of a pharmacy service administration organization, as defined, to receive a copy of the contract provisions application to the pharmacy. Provides for continued liability for payment due for services rendered following termination of a pharmacist or pharmacy from a pharmacy benefits manager network, excluding cases of fraud, waste and abuse. Clarifies that pharmacy benefits managers are subject to HIPPA.

    Establishes the following enforcement provisions. Authorizes the Commissioner to examine any pharmacy benefits manager's affairs to determine compliance with the Article. Authorizes the Commissioner to retain attorneys, independent actuaries, independent CPAs, or other professional and specialists as examiners, at cost to the pharmacy benefits manager. Provides for confidentiality of examinations. Deems violations of the Article subject to the existing civil penalties under GS 58-56A-30, as recodified, as well as license denial or revocation after notice and hearing. Makes conforming changes to repeal the existing procedure for the Department of Insurance to report any Article violations to the Attorney General. 

    Directs the Commissioner to adopt implementing rules. 

    Makes clarifying changes. 

    Amends GS 58-2-40 to require the Commissioner to report to the Attorney General any violations of pharmacy benefits managers.

    Amends GS 58-56-2 to exclude a licensed pharmacy benefits manager from the definition of a third party administrator as the term applies to Article 56.

    Effective October 1, 2021, and applies to any contracts entered into, renewed, or amended on or after that date. 


  • Summary date: Mar 11 2021 - More information

    To be summarized.


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