Healthcare (Prescription Drugs)

HB 163 regulates Pharmacy Benefits Managers (PBMs) to ensure fair practices for pharmacies and insured individuals. The bill prohibits PBMs from charging insurers more for a prescription drug than they pay the pharmacy (spread pricing) and requires patient out-of-pocket costs to be based on the net price after any PBM concessions. It establishes minimum reimbursement standards for pharmacies, preventing PBMs from paying less than the national average drug acquisition cost plus a dispensing fee. Additionally, it clarifies that PBMs cannot restrict accredited pharmacies from dispensing specialty drugs and strengthens audit protections for pharmacies.

SB 357 expands and modernizes collaborative practice agreements between physicians and pharmacists. It allows licensed pharmacists, designated as "clinical pharmacist practitioners," to provide a broader range of "health care services" under a physician's supervision, including modifying drug dosages, ordering tests, and managing drug therapy for patients. These services must be conducted under specific, written collaborative practice agreements and adhere to rules set by the North Carolina Medical Board and Board of Pharmacy. The bill also permits therapeutic drug substitutions by pharmacists with physician authorization and allows for multi-provider collaborative agreements in institutional settings.

SB 479, the SCRIPT Act, requires health insurers in North Carolina to allow patients to choose any participating pharmacy without restrictions. It prohibits insurers from imposing unequal copayments, financial penalties, or incentives that steer patients toward specific pharmacies. The bill directly affects insurers offering prescription drug coverage, independent pharmacies (defined as groups of 10 or fewer under common ownership), and patients seeking pharmacy services. Key provisions ensure equal treatment for all pharmacies in a plan and prevent insurers from limiting patient choice based on financial incentives.