ACCESS TO PRESCRIPTION DRUG COST INFORMATION.

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View NCGA Bill Details2021
House Bill 178 (Public) Filed Thursday, February 25, 2021
AN ACT TO REQUIRE ACCESS TO ACCURATE PRESCRIPTION DRUG BENEFIT COST INFORMATION.
Intro. by Sasser, Adcock, Potts, K. Baker.

Status: Ref To Com On Rules and Operations of the Senate (Senate action) (May 12 2021)
H 178

Bill Summaries:

  • Summary date: May 11 2021 - View Summary

    House committee substitute makes the following changes to the 1st edition. 

    Revises the definitions set forth for new Article 56B, Access to Prescription Drug Benefit Cost Information, in GS Chapter 58. Modifies health care services to include procedures or services rendered by a prescriber or health care provider that meet the specified criteria (was, limited to rendering by a health care provider). Includes a health maintenance organization that prescribes drugs to individuals or groups under contracts issued or delivered in the State in the defined term payor. Replaces the definition for real time to now define the term as exchange of patient eligibility, product coverage, and benefit financials for a choice product and pharmacy and identification of coverage restrictions and alternatives when they exist, delivered immediately after product selection using electronic prescribing platforms or systems (was, defined as delivered immediately after collection). Revises the criteria for the term therapeutically equivalent alternative to include that the prescription drug uses real-time prescription benefit standards developed by an organization accredited by the American National Standards Institute.

    Revises the new Article as follows. Makes technical and clarifying changes to the required electronic provision of certain information relating to prescription price transparency and patient access to prescribed medications; corrects a statutory cross-reference. Adds prescribers to the electronic health record entities involved in the process of prescribing, dispensing, paying for, and exchanging information relating to prescription drugs which must partner with intermediaries to ensure the delivery of accurate patient-specific prescription price transparency information. Now requires prescribers, alternatively to providers, to communicate to a patient the most therapeutically appropriate treatment for the patient's diagnosis and the drug cost information, therapeutically equivalent alternatives, and delivery options. Adds that a pharmacist filling a prescription for a specific biological product can substitute an interchangeable biological product only if (1) the prescriber has not indicated that the pharmacist cannot substitute an interchangeable biosimilar biological product for the prescribed biological product and (2) the FDA has determined the biological product to be substituted is interchangeable with the prescribed biological product. Changes the act's effective date to January 1, 2023 (was, July 1, 2021).


  • Summary date: Feb 25 2021 - View 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.