Requires UNC’s School of Medicine's Area Health Education Center (UNC AHEC) to consult with the Department of Health and Human Services, the North Carolina Medical Board, North Carolina Board of Nursing, North Carolina Medical Society, North Carolina Pediatric Society, North Carolina Board of Pharmacy, North Carolina Academy of Family Physicians, and the North Carolina Nurses Association to gather evidence-based information on sudden unexpected death in epilepsy from publications and nonprofit organizations to create standard information to provide to all health care practitioners in this State. Specifies that the information must include, at a minimum, current and evidence-based information about sudden unexpected death in epilepsy risk factors and conditions and contact information for nonprofit organizations that provide support services for epilepsy conditions. Requires that the information be made available on the NC AHEC’s website and readily accessible to health care practitioners in this State. Requires NC AHEC to report to the specified NCGA committee a completed summary or booklet of information provided to health care practitioners in the report by no later than September 1, 2025.  

Section 1.

Prohibits a pharmacy benefits manager (Manager), in new GS 58-58A-6, from charging an insurer offering a health benefit plan a price for a prescription drug that differs from the amount the pharmacy benefits manager directly or indirectly pays the pharmacy or pharmacist for providing pharmacist services under that same health benefit plan. Adds four new terms to GS 58-56A-1 (definitions provision of the pharmacy benefits management article in GS Chapter 58), including concession (a reduction in the cost of a prescription drug that a pharmacy benefits manager negotiates with a drug manufacturer or wholesale distributor. A concession includes fees, discounts, rebates, or other reductions in the cost to the pharmacy benefits manager. A concession does not include a bona fide service or administrative fee.) Directs a Manager, in GS 58-56A-3(c3), when calculating an insured's out-of-pocket cost for a covered prescription drug, 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 pharmacy benefits manager has received or will receive. Specifies that the current retail price cannot be used when calculating an insured's out-of-pocket cost for a prescription drug if the pharmacy benefits manager has received, is receiving, or will receive any concessions associated with that particular prescription drug.

Prevents a Manager from charging a pharmacy or pharmacist a fee related to the adjudication of a claim under GS 58-56-A4 (currently, a Manager can charge such a fee if certain conditions are met). Prohibits Managers from engaging in any of six listed practices, including basing pharmacy reimbursement on patient outcomes, scores, or metrics. Requires pharmacies and pharmacists to obtain a specialty pharmacy accreditation under the NC Pharmacy Practice Act when dispensing certain specialty drugs (as defined). Narrows the circumstances in which a claim may be retroactively denied or reduced, by disallowing retroactive denials or reductions when the adjustments are part of an attempt to limit overpayment recovery efforts by a Manager. Makes conforming changes.

Prohibits Managers, in GS 58-56A-15, from: (1) requiring multiple specialty pharmacy accreditations as a prerequisite for participation in a retail pharmacy network that dispenses specialty drugs; (2) from denying the right of any properly licensed pharmacist or pharmacy that has a specialty drug accreditation to participate in a retail pharmacy network that includes network participants that dispense specialty drugs on the same terms and conditions of other similarly situated participants in the network; and (3) from charging a pharmacist or pharmacy a fee related to participating in a retail pharmacy network. Makes a technical change.

Requires Managers, effective April 1, 2026, to submit quarterly reports under new GS 58-56A-22 on the four listed matters to the Insurance Commissioner. Designates the report information confidential and not subject to disclosure under State public records law. Starting August 1, 2026, requires the Commissioner to submit an annual report based on aggregate data received by the Managers. Requires posting of the report to the Department of Insurance (DOI) website. 

Amends GS 58-56A-25 by making Article 4C (Pharmacy Audit Rights) of GS Chapter 90 applicable to an audit of a pharmacy or pharmacist by a Manager, insurer, or third-party administrator and specifies that the provisions are enforceable by the Commissioner. 

Applies to contracts of insurance issued, renewed, or amended on or after October 1, 2025.

Allows the Commissioner to adopt temporary rules to implement these provisions.

Section 2.

Broadens the scope of GS 58-51-37 (concerning pharmacy of choice) by: (1) removing the exemptions for those entities that have its own facility, employs or contracts with physicians, pharmacists, nurses, and other health care personnel, and that dispenses prescription drugs from its own pharmacy to its employees and to enrollees of its health benefit plan and (2) removing limitation that health benefit plans providing pharmacy services must be providing those services to State residents for the statute to apply. Adds new defined terms insured (any individual covered by a health benefit plan) and insurer. Amends defined terms health benefit plan and copayment. Adds an additional prohibited health benefit plan term preventing any such plan from imposing on an insured person any copayment, amount of reimbursement, number of days of a drug supply for which reimbursement will be allowed, or any other payment or condition relating to the purchase of pharmacy services or products, including prescription drugs, from any pharmacy that is more costly or more restrictive than that which would be imposed upon the insured if the same services or products were purchased from either a mail-order pharmacy or any other pharmacy that is willing to provide the same services or products for the same cost and copayment as any mail-order service. Removes the Commissioner’s power to impose civil penalties or restitution for violations of the statute under GS 58-2-70. Instead, specifies that a violation of this statute creates a civil cause of action for damages or injunctive relief in favor of any person or pharmacy aggrieved by the violation. Makes clarifying, technical, and organizational changes. Recodifies the term generic equivalent in GS 58-56A-3 (consumer protections) to GS 58-56A-1 (definitions provision of the article).

Further amends those definitions in GS 58-56A-1, as amended by Section 1, discussed above, to include new terms high-deductible health plan and Section 223. Makes technical and clarifying changes to term generic equivalent. Prevents a Manager from prohibiting an insured’s selection of a pharmacy or pharmacist with respect to any pharmacy or pharmacist that has agreed to participate as a provider in a health benefit plan's network according to the terms offered by the insurer. Makes other clarifying and conforming changes to GS 58-56A-3. Repeals GS 58-56A-50(c) (applying the provisions of GS 58-51-37 pertaining to pharmacy of choice to Managers with respect to 340B covered entities and 340B contract pharmacies). Applies to contracts of insurance issued, renewed, or amended on or after October 1, 2025.

Allows the Commissioner to adopt temporary rules to implement these provisions.

Section 3.

Narrows the scope of a pharmacy records audit to 25 total prescriptions, including refills (currently, 100 selected prescriptions) under GS 90-85-50 (pharmacy rights during audit by insurer or other entity responsible for payment of a benefits claim). Guarantees the pharmacy written notice of the basis of any additional claims triggered by the audit, including a specific description of any suspected fraud or abuse, at least 14 days prior to any additional audit. Makes technical changes. Requires, in new GS 90-85-52(a1) for the entity conducting the audit to provide the pharmacy with a summary of the total recoupment amount and the date on which the recoupment will be assessed, along with described documentation. Specifies that pharmacy audit rights apply to an audit of a pharmacy or pharmacist conducted by a Manager, insurer, or third-party administrator and is enforceable against these entities by the Commissioner. Applies to audits conducted on or after October 1, 2025. Allows the NC Board of Pharmacy to adopt temporary rules to implement these provisions. 

Adds new GS 143B-156.1 establishing a Child and Family Welfare Ombudsman Office (Office) to focus on youth, birth families, and resource parents that are directly involved in the North Carolina child welfare system, within the Department of Health and Human Services (DHHS) and reporting directly to DHHS’s Secretary. Sets forth five sub-issues of focus. Directs the Office to advocate on behalf of these populations in this State and support their rights to ensure their voices are heard and concerns are addressed. Sets forth requirements for Ombudsmen and Office staff, including that staff have worked or lived experience in the foster care system. Lists nine powers and duties of the Office, including: (1) to investigate and attempt to resolve hindrances and issues for families or individuals seeking approval for licensure as a family foster home or therapeutic foster home and current resource parents navigating compliance with existing State and federal laws and rules; (2) providing information and assistance to resource parents; (3) gathering information through interviews and directly accessing case information within court and State databases; and (4) formulating a process for mediation between parties. Requires the Office to maintain neutrality in exercising its duties. Designates all communication between the Office and prospective resource parents or individuals seeking assistance from the Office as confidential and not to be considered public records under GS Chapter 132. Provides for whistleblower protections to persons for reporting a violation of law or ethical concerns to the Office. Directs the Office to conduct a review of every such report and to determine the correct action to take to protect the whistleblower. Requires the Office, by October 1 of each year, to compile data and submit it to the Office of the Governor and DHHS detailing the number of inquiries and complaints handled by the Office and trends in recurring issues for resource parents and local county departments of social services, including quantitative and qualitative data, which should be anonymized. Provides for publication of the data on the Office’s website. Requires the Office to submit an annual report to the specified NCGA committee based on the data by no later than November 1 of each year. Appropriates $137,000 for 2025-26 and $145,000 for 2026-27 to DHHS establish the Office and hire one full-time equivalent employee. Effective July 1, 2025.

Directs DHHS to have the Office operational by January 1, 2026, and engage in appropriate rulemaking to implement the act. 

Enacts new GS 14-269.9 making it a Class 2 misdemeanor to leave a firearm in an unattended motor vehicle unless the vehicle is locked and the firearm is either: (1) secured with a trigger lock or other safety device designed to prevent an unauthorized user from operating the firearm or (2) in a locked container. Applies to offenses committed on or after December 1, 2025.

Adds new GS 126-14.7, entitled, “Equality and merit in State government workspaces; no DEI,” as follows. Directs that no State agency can promote, support, fund, implement, or maintain workplace diversity, equity, and inclusion (DEI) programs, policies, or initiatives, including, but not limited to, using DEI in State government hirings and employment; maintaining dedicated DEI staff positions or offices; or offering or requiring DEI training. Defines the following:

1. Differential treatment: Any distinction, exclusion, or difference in policy practice, or action that impairs equal access to opportunities or benefits, based on a protected characteristic. This definition does not apply to antidiscrimination measures, reasonable accommodations, legal requirements, or bona fide occupational qualifications.
2. Diversity, equity, and inclusion or DEI training: A program, policy, initiative, or activity designed or implemented to: a. Influence hiring or employment practices with respect to race, sex, color, ethnicity, nationality, country of origin, or sexual orientation other than through the use of merit-based hiring processes in accordance with any applicable State and federal antidiscrimination laws. b. Promote differential treatment of or providing special benefits to individuals on the basis of race, sex, color, ethnicity, nationality, country of origin, or sexual orientation.
3. Protected characteristic: Any trait protected by State or federal antidiscrimination laws.

Specifies that the statute is not to be construed to conflict with or prohibit compliance with (as applicable) First Amendment speech rights, Title IX of the Education Amendments of 1972, as amended; the Americans with Disabilities Act, as amended; the Age Discrimination in Employment Act, as amended; Title VI of the Civil Rights Act of 1964; or other applicable State or federal law.

Directs the State Auditor to conduct periodic compliance audits and to report any violations to the specified NCGA commission and the NCGA itself.

Makes it a Class 1 misdemeanor to knowingly and willingly violate the statute and subjects any State officer or employee who violates the statute to removal from office. Creates two civil actions arising from violations of the statute: (1) for employees of a State agency for damages to the employee resulting from a violation of the statute and (2) for injunctive relief, declaratory relief and attorneys’ fees by any person. Provides for venue. Contains a severability clause.

Amends GS 126-5 so that the above applies to nonexempt State employees in the executive branch, including nonexempt employees of The University of North Carolina and nonexempt employees of the Community Colleges System Office, and community college employees.

Adds new GS 143-162.8, entitled “No public funds for DEI,” as follows. Prevents a State agency, unit of local government, or non-State entity from using any State funds or public monies to promote, support, fund, implement, or maintain DEI initiatives or programs. Prevents these programs from applying for, accepting, or using federal funds, grants, or other financial assistance that require compliance with DEI policies, initiatives, or mandates. Directs that any existing programs funded through such means must be discontinued unless continued participation is expressly required by federal law. Defines DEI, non-State entity, public monies, State agency, State funds, and unit of local government. Further directs that the above prohibitions include, but are not limited to using State funds or public monies to:

• Utilize DEI in hirings, employment, admissions, or the awarding of contracts.
• Offer or require DEI training.
• Maintain DEI offices or dedicated staff positions, whether permanent, time-limited, full-time, part-time, or temporary.

Clarifies that the statute must not be construed to conflict with First Amendment speech rights, Title IX of the Education Amendments of 1972, as amended; the Americans with Disabilities Act, as amended; the Age Discrimination in Employment Act, as amended; Title VI of the Civil Rights Act of 1964; or other applicable State or federal law.

Directs that the statute cannot be construed to apply to any of the following:

1. Academic course instruction.
2. Scholarly research or a creative work by an institution of higher education's students, faculty, or other research personnel or the dissemination of that research or work.
3. An activity of a student organization registered with or recognized by an institution of higher education.
4. Guest speakers or performers on short-term engagements.
5. A policy, practice, procedure, program, or activity to enhance student academic achievement or postgraduate outcomes that is designed and implemented without regard to race, sex, color, or ethnicity.
6. Data collection.
7. Bona fide qualifications based on sex which are reasonably necessary to the normal operation of public higher education, including, but not limited to: a. Sports teams organized by sex. b. Single-sex bathrooms and locker rooms. c. Requiring a maintenance employee assigned to a single-sex locker room to be a member of that respective sex. d. Fraternities and sororities restricted to members of one sex. e. Having single-sex housing options for students.

Makes it a Class 1 misdemeanor to knowingly and willfully violate the statute. Requires annual posting of compliance measures by each State agency, unit of local government, and non-State entity starting February 1, 2026, as well as submission to the State Auditor. Directs the State Auditor to submit an annual report to the specified NCGA Committee starting on April 1, 2026. Directs the State Auditor to conduct periodic compliance audits and to report any violations to the specified NCGA commission and the NCGA itself.  

Specifies that a violation of the statute is subject to the applicable penalty provisions of Article 10 of GS Chapter 143C, Article 11 of GS Chapter 159 of the General Statutes, GS 143C-6-22, or GS 159-183. Creates two civil actions arising from violations of the statute: (1) for State, local government, and non-State entity employees for damages to the employee resulting from a violation of the statute and (2) for injunctive relief, declaratory relief and attorneys’ fees by any person. Provides for venue. Provides that the statutory remedies list above are in addition to any other remedies available. Contains a severability clause.

Makes conforming changes to GS 143C-10-1 to account for new misdemeanor.

Expands the civil liability provisions under GS 143C-10-2 to: (1) direct a State agency or non-State entity receiving public funds to pursue the recoupment of misspent funds by all lawful means available, including the filing of a civil action in the General Court of Justice and (2) authorize any person to bring a civil action for a violation of this section seeking injunctive or declaratory relief and the recovery of reasonable attorneys' fees and costs. Requires the Governor to report facts leading to suspension of an executive branch officer or employee under GS 143C-10-3 to the DA in the county where all or a substantial part of the violation occurred along with the Attorney General. Authorizes any person to bring a civil action for a violation of GS 159-80 (removal of offending local government officers and employees from office) seeking injunctive or declaratory relief and the recovery of reasonable attorneys' fees and costs along with rules of venue. Requires the Commission to also report the circumstances of suspension or removal to the DA for county in which all or a substantial part of the noncompliance occurred. Makes technical changes.

Adds new GS 159-183, pertaining to violations of GS 143-162.8, laying out misdemeanor set forth above along with providing that offending officer or employee is subject to removal from their office or employment. Directs that violators are liable for any damages suffered by a unit of local government in consequence of the offense. Requires local government to recoup misspent funds in a civil action filed in the General Court of Justice.

Directs that the penalty provisions set forth above apply to acts or omissions occurring after the act becomes law.