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  • Summary date: Mar 22 2023 - View Summary

    Amends Part 7 of Article 50 of GS Chapter 58 by enacting GS 58-50-296, pertaining to reimbursement and coverage of services provided by pharmacists, as follows.  Defines health care services and pharmacist.

    Requires insurers offering health plan benefits in the State to do the following as it relates to pharmacists:

    • If the health benefit plan delegates credentialing agreements to contracted health care facilities, it must also accept credentialing for pharmacists employed or contracted with those facilities.
    • Reimburse a contracted health care facility or contracted pharmacist directly for covered services performed by a pharmacist within that pharmacist’s scope of practice, whether or not the pharmacist is a participating provider in the insurer’s network.
    • Reimburse a pharmacist at the same rate that other advanced practice or mid-level health care providers, such as nurse practitioners or physician assistants, are reimbursed when providing the same or equivalent health care services or procedures if: (i) the service or procedure was performed within the pharmacist's licensed lawful scope of practice; (ii) the health benefit plan would have provided reimbursement if the service or procedure had been performed by another health care provider; and (iii) the pharmacist provided the service or procedure in compliance with any requirements of the insurer related to the service or procedure.

    Specifies that the participation of a pharmacy in a drug benefit provider network of an insurer offering a health benefit plan in this State will not satisfy any requirement that insurers offering health benefit plans include pharmacists in medical benefit provider networks.

    Specifies that the statute also applies to agents of insurers offering a health benefit plan in the State and third-party insurance plan administrators. 

    Effective October 1, 2023, and applies to contracts entered into, renewed, or amended on or after that date.