Bill Summary for S 493 (2013-2014)

Summary date: 

Jun 25 2014

Bill Information:

View NCGA Bill Details2013-2014 Session
Senate Bill 493 (Public) Filed Wednesday, March 27, 2013
AN ACT TO PROVIDE FOR VARIOUS ADMINISTRATIVE REFORMS OF THE HEALTH AND SAFETY LAWS BY UPDATING OUTDATED STATUTES AND REGULATIONS AND MODERNIZING OR SIMPLIFYING CUMBERSOME OR OUTDATED REGULATIONS, BY STUDYING HEALTH AND SAFETY MATTERS OF CONCERN TO NORTH CAROLINA CITIZENS, AND BY MAKING VARIOUS OTHER STATUTORY CHANGES.
Intro. by Walters.

View: All Summaries for BillTracking:

Bill summary

House amendments make the following changes to the 5th edition:

Amendment  #1 

Amends GS 131E-6(3) to provide that limited liability companies formed under GS 57D and a foreign limited liability company which has procured a certificate of authority to transact business in North Carolina are considered to be corporations authorized to do business in North Carolina. Effective October 1, 2014.

Amendment #2

Amends proposed GS Chapter 58, Article 56A, Pharmacy Benefits Management, deleting language in the definition for health benefit plan which excluded any entity retained by the State Health Plan for Teachers and State Employees while performing under contract with the plan. Deletes the following terms and definitions: pharmacy benefits management, therapeutically equivalent drug substitute, and widely available. Amends the definition for maximum allowable cost to be the maximum per-unit reimbursement for multiple-source prescription drugs, medical products, or devices and now defines pharmacy benefits manager as an entity that contracts with a pharmacy on behalf of an insurer or third-party administrator to administer or manage prescription drug benefits. Provides new procedures for placing a prescription drug on the maximum allowable cost price list, including that it must be available for purchase by pharmacies in North Carolina from national or regional wholesalers, must not be obsolete, and must meet one of two conditions: (1) the drug is listed as “A” or “B” rated in the most recent version of the US Food and Drug Administration’s Approved Drug Products (Orange Book) or (2) the drug has an “NR” or “NA” rating  or a similar rating by a nationally recognized reference. Adds requirement that prompt review of current prices in electronic, print, or telephonic format be available to contracted pharmacies within one business day of the removal or modification.  Effective January 1, 2015.

Requires a pharmacy benefits manager to adjust or remove (was, remove) the maximum allowable cost price for a prescription drug to remain consistent with marketplace changes.

Deletes provisions related to pharmacy benefits managers disclosing specified information.

Deletes proposed GS 58-56A-5, appeals of maximum allowable cost prices.

Adds new areas that must be covered in the study by the Department of Insurance. Now requires the study to evaluate the frequency of disclosure of methodology for calculating maximum allowable cost prices by the pharmacy benefits management companies and the appeals procedures for pharmacies relating to the maximum allowable cost pricing.

Amendment #3

Amends Section 12G.1(a) of SL 2013-360 to provide that beginning July 31, 2013, and ending July 1, 2015 (was, July 1, 2016), the Department of Health and Human Services, Division of Health Services Regulation (Division), will not issue any licenses for special care units as defined in GS 131D-4.6 and GS 131E-114. Provides an exemption on the moratorium on licenses, allowing the Division to issue a license to a facility that was in possession of a certificate of need as of July 1, 2013, which included an authorization to operate special care unit beds. 

Amendment #5

Enacts new GS 58-3-282, Coverage for orally administered anticancer drugs, requiring every health benefit plan that provides coverage for prescribed, orally administered anticancer drugs that are used to kill or slow the growth of cancerous cells and that provides coverage for intravenously administered or injected anticancer drugs to provide coverage for prescribed, orally administered anticancer drugs on a basis no less favorable than the coverage provided for the intravenously administered or injected anticancer drug. Prohibits coverage for orally administered anticancer drugs from being subject to prior authorization, dollar limit, co-payment, coinsurance, deductible provision, or any other out-of-pocket expense that does not apply to intravenously administered or injected anticancer drugs. Prohibits achieving compliance by reclassifying drugs or increasing expenses imposed on anticancer drugs.

Provides that any insurer that limits the total amount paid by a covered person through all in-network, cost-sharing requirements to no more than $100 per filled prescription for any oral anticancer drug will be considered in compliance with the statute. Provides for what is included in cost-sharing requirements.

Effective January 1, 2015, applying to insurance contracts issued, renewed, or amended on or after that date. This section does not become effective if it is determined by the federal government to create a state-required benefit that is in excess of the essential health benefits.

© 2021 School of Government The University of North Carolina at Chapel Hill

This work is copyrighted and subject to "fair use" as permitted by federal copyright law. No portion of this publication may be reproduced or transmitted in any form or by any means without the express written permission of the publisher. Distribution by third parties is prohibited. Prohibited distribution includes, but is not limited to, posting, e-mailing, faxing, archiving in a public database, installing on intranets or servers, and redistributing via a computer network or in printed form. Unauthorized use or reproduction may result in legal action against the unauthorized user.

Printer-friendly: Click to view