This North Carolina bill allows taxpayers to deduct up to $5,000 of unreimbursed costs for prescribed medications and pharmacy fees from their state income tax. The deduction applies to expenses not covered by tax-advantaged accounts like Flexible Spending or Health Savings Accounts and prevents double-dipping if a federal deduction is already claimed for the same year. Effective for tax years starting on or after January 1, 2026, the measure directly affects individuals paying out-of-pocket for prescription drugs who itemize their state taxes.
This bill aims to lower healthcare expenses and shield patients from unexpected financial burdens by establishing new rules for insurance plans and medical billing. It directly affects individuals with health insurance, hospitals, and insurance companies operating in North Carolina. Key provisions include capping annual out-of-pocket costs for prescription drugs at $2,000, prohibiting surprise billing for nonemergency care at in-network facilities, and delaying the reporting of unpaid medical bills to credit agencies until 180 days past due. Additionally, the legislation requires hospitals to publicly report negotiated prices for common medical procedures and mandates that emergency ground ambulance services be covered under standard health benefit packages.
This bill expands the legal definition of an independent pharmacy in North Carolina to include community-based pharmacies owned by small groups with ten or fewer locations. The law specifically covers businesses that are not publicly traded and focus primarily on pharmacy services. Additionally, the legislation allocates $100,000 from the state's general fund to the Department of Insurance to help enforce these new rules starting in the 2026-2027 fiscal year.
This North Carolina legislation aims to reduce healthcare expenses and boost competition by adding a low-cost plan option to the state's insurance marketplace. It establishes a purchasing consortium for public entities to negotiate better rates and allocates funds for chronic disease prevention initiatives. The bill also removes regulatory barriers for rehabilitation facilities and limits hospital consolidation to maintain market diversity. These provisions impact residents seeking coverage, public employers, healthcare providers, and hospital systems within the state.
HB 75, the Pharmaceutical Full Disclosure Act, requires prescription drug manufacturers to clearly disclose specific information in advertisements targeting North Carolina consumers. It mandates that ads include the FDA approval date for the drug's use, the date the drug first became available to U.S. consumers, and detailed clinical trial data for required side effects (such as trial length, participant numbers, and side effect frequency). The law applies to all advertisements via TV, internet, print, or radio in North Carolina published on or after October 1, 2025, directly affecting drug manufacturers and their marketing materials. This policy change aims to provide clearer, evidence-based information about prescription drugs in promotional content.
SB 517 requires hospitals and clinics participating in the federal 340B Drug Pricing Program (which provides discounted drugs to safety-net providers) to charge patients no more than the actual cost they paid for those drugs. It also mandates annual public reporting by these "covered entities" starting in 2026, including details on 340B drug costs, payments received from insurers/patients, charity care expenses, and contracts with pharmacies. The bill specifies that covered entities must disclose how many prescriptions used 340B drugs, whether they passed discounts to low-income patients, and financial details about pharmacy partnerships. All submitted reports will be posted online by the state health department for public access. This law directly affects North Carolina hospitals and clinics enrolled in the federal 340B Program.
SB 414 allows licensed pharmacists (specifically clinical pharmacist practitioners) to test for and treat certain conditions like influenza, COVID-19, and strep throat using FDA-approved CLIA-waived tests, without requiring a physician referral. It mandates that health insurers cover these pharmacist-provided services at the same level as services from other healthcare providers, if performed within the pharmacist’s scope of practice. The bill prohibits pharmacists from treating conditions with controlled substances (Schedules I-IV) and requires statewide protocols for implementation by October 1, 2025. This directly affects pharmacists, patients seeking these specific services, and health insurers across North Carolina.
HB 624 requires drug manufacturers to notify state agencies, insurers, and pharmacy benefit managers 60 days before raising prices on prescription drugs by 10% or more in a year. Manufacturers must disclose the justification for price hikes, previous marketing budgets, and historical pricing data within 30 days of notification. The bill also mandates rapid disclosure of pricing for new FDA-approved drugs and requires manufacturers to inform prescribers if a drug contains ingredients known to cause dependency. The state will create a public online portal for transparency, including annual reports on the most prescribed, costliest, and fastest-increasing drugs, but does not set price limits.
Senate Bill 335 allows pharmacists to order and perform CLIA-waived tests to treat influenza, provided they follow statewide protocols and do not use controlled substances. The bill mandates that health benefit plans cover healthcare services provided by pharmacists if the services are within their licensed scope of practice and would be covered if performed by another healthcare provider. It also ensures consistent application of prescription drug and pharmacy service coverage requirements across insurers, third-party administrators, and pharmacy benefits managers. These changes aim to expand access to certain healthcare services through pharmacists, affecting patients, pharmacists, and health insurance providers. Most provisions become effective October 1, 2025.
SB 287 prohibits health insurers from using artificial intelligence algorithms as the sole basis to deny, delay, or modify healthcare services based on medical necessity. The bill requires that only licensed and qualified healthcare providers make these determinations, and insurers must verify that third-party contractors (like pharmacy benefits managers) comply with this rule. It directly affects health insurers, pharmacy benefits managers, and the North Carolina State Health Plan for teachers and state employees, which must review its contracts and practices for compliance. The law takes effect 30 days after enactment and focuses on ensuring human medical judgment remains central to coverage decisions.
