Conference committee substitute to the 6th edition makes the following changes.

Part I.

Further amends GS 58-51-37 (pharmacy of choice) to reinstate the following new defined terms removed from the 6th edition as they appeared in the 5th edition, with the following changes: housing unit, independent pharmacy, pharmacy desert, rural, and urban. Amends the definition of independent pharmacy to now mean a pharmacy that is part of a group of 10 or fewer (was, five or fewer) pharmacies under common ownership, including a pharmacy that is part of a group of one. Adds to (c)(4) to exclude those monetary advantages imposed upon a pharmacy located in a pharmacy desert or a county with a population of fewer than 20,000 residents from prohibited monetary advantage practices. Deletes new (c)(7) which proposed to prohibit an insurer from imposing upon an insured 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 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 willing to provide the same services or products for the same cost and copayment as any mail-order service.

Part II.

Reinstates GS 58-56B-40 removed in the 6th edition as it appeared in the 5th edition, providing financial penalties if any Pharmacy Services Administrative Organization (PSAO) fails to comply with the provisions of new Article 56B of GS Chapter 58. Makes technical changes to Part II’s effective date.

Part III.

Removes generic equivalent and national average drug acquisition cost from the defined terms in GS 58-56A-1 (pertaining to pharmacy benefits management). No longer includes prescriptions for medications classified as a specialty drug as determined by a health benefit plan in the new term specialty drug. No longer specifies that the standards applicable to specialty pharmacies apply to specialty drugs from wholesalers and exclude rebates and discounts. Adds that the National Association of Boards of Pharmacy (NABP) can issue the accreditation to a specialty pharmacy. 

Amends new GS 58-56A-22 (Reporting requirements for transparency) to remove the reporting requirements of pharmacy benefits managers to insurers set forth in previous subsection (b).

Removes language preventing a pharmacy benefits manager (PBM) from reimbursing a pharmacy or pharmacist for a prescription drug in an amount less than the national average drug acquisition cost for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee, in GS 58-56A-4(g). Instead reinstates subsection (g) as it appeared in the 5th edition, preventing a PBM contract from requiring directly or indirectly or through a pharmacy services administration organization, an independent pharmacy, or any pharmacy in a pharmacy desert to accept reimbursement for providing a covered prescription drug, device, or service at a rate less than the acquisition cost for the covered drug, device, or service. Adds statutory cross-references to defined terms. Reinstates companion provisions from the 5th edition designating violations of GS 58-56A-4(g) an unfair trade practice.

Changes the caption of new GS 58-56A-6. No longer prohibits PBMs 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. Instead requires PBMs charging the described price to quarterly report the aggregate difference between the price charged the insurer and the price paid to the pharmacy or pharmacist for each drug where there is a difference in price, beginning March 31, 2026. Requires insurers receiving a spread pricing report to make the report available on its website and to any employers who have purchased a health benefit plan from the insurer. Requires that any pharmacy benefits manager who is obligated to make a report under the section and (ii) is in a contractual relationship with an employer who has purchased a health benefit plan from an insurer submit the report directly to the employer.

Part IV.

Adds to GS 58-56A-15 to require a PBM pharmacy provider network to meet or exceed the Medicare Part D program standards for convenient access to network pharmacies under 42 C.F.R. 423.120.

Part V.

Removes proposed changes to GS 90-85.3A (practice of pharmacy). Makes conforming organizational changes.

Part XI.

Adds the following. Extends the sunset provision for the described reimbursement rate for covered outpatient drugs and the professional drug dispensing fee under Medicaid set forth in Section 9D.19A, SL 2021-180, as amended, from June 30, 2026, to June 30, 2031.