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

Part III.

Enacts GS 58-56A-23, requiring the Department of Insurance (DOI) to identify any pharmacy deserts and then publish a list of those pharmacy deserts on its website and report its findings to the specified NCGA committee. Requires the initial publication and report to be made by January 1, 2026, with updates every four years and by no later than 12 months after the release of decennial federal census data.  Makes conforming changes.

Removes defined term retail community pharmacy from GS 56-56A-1 (Pharmacy Benefits Management). Removes reference to “retail community pharmacy” in GS 58-56A-4 (preventing a pharmacy benefit manager contract from requiring the described pharmacies in a pharmacy desert from accepting reimbursements for less than the acquisition cost of the covered described benefit) and replaces it with “any pharmacy.”

Requires DOI to adopt rules to implement the provisions of Part III of the act by October 1, 2025, including rules establishing the pharmacy desert designation.

Part V.

Incorporates pharmacy desert (as defined in GS 58-51-37) into GS 90-85.3 (definitions pertaining to the NC Pharmacy Practice Act). Expands the scope of new GS 90-85.21E (pertaining to allowed denials of prescription fills or refills by independent pharmacies) to extend to the statute's provisions pharmacists in a pharmacy desert. Removes provisions allowing an independent pharmacy to decline to fill or refill a prescription if the pharmacist will be paid less or is paid less than the acquisition cost of the drug, device, or service covered (but retains provision allowing an independent pharmacy to decline to fill or refill the prescription if the independent pharmacy will be paid or is paid less). Makes conforming changes, including to the statute's title.

Part VIII.

Extends the Part’s effective date from October 1, 2025, to January 1, 2027.