GENERAL ASSEMBLY OF NORTH CAROLINA
HOUSE BILL 466*
Short Title: The Pharmacy Patient Fair Practices Act.
Representative Brenden Jones.
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
Insurance, if favorable, Health
March 27, 2017
A BILL TO BE ENTITLED
AN ACT relating to the regulation of pharmacy benefit managers.
The General Assembly of North Carolina enacts:
SECTION 1. G.S. 58‑56A‑1 reads as rewritten:
"§ 58‑56A‑1. Definitions.
The following definitions apply in this Article:
(1) Health benefit plan. – As defined in G.S. 58‑50‑110(11). This definition specifically excludes the State Health Plan for Teachers and State Employees.
(2) Insured. – An individual covered by a health benefit plan.
(2)(3) Insurer. – Any
entity that provides or offers a health benefit plan. (3)(4) Maximum
allowable cost price. – The maximum per unit reimbursement for multiple source
prescription drugs, medical products, or devices.
(5) Pharmacist. – A person licensed to practice pharmacy under Article 4A of Chapter 90 of the General Statutes.
(4)(6) Pharmacy. – A
pharmacy registered with the North Carolina Board of Pharmacy. (5)(7) Pharmacy
benefits manager. – An entity who contracts with a pharmacy on behalf of an
insurer or third‑party administrator to administer or manage prescription
drug benefits. (6)(8) Third‑party
administrator. – As defined in G.S. 58‑56‑2."
SECTION 2. Article 56A of Chapter 58 of the General Statutes is amended by adding three new sections to read:
"§ 58‑56A‑2. Pharmacy of choice.
A pharmacy benefits manager shall comply with the pharmacy of choice requirements under G.S. 58‑51‑37.
"§ 58‑56A‑3. Consumer protections.
(a) A pharmacy benefits manager shall not prohibit a pharmacist or pharmacy from providing an insured information regarding the amount of the insured's cost share for a prescription drug and the clinical efficacy of a lower‑priced alternative drug, if one is available. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing any information described in this section or for selling a lower‑priced drug to the insured if one is available.
(b) A pharmacy benefits manager shall not prohibit a pharmacist or pharmacy from offering and providing store direct delivery services to an insured as an ancillary service of the pharmacy.
(c) A pharmacy benefits manager shall not charge, or attempt to collect from, an insured a co‑payment that exceeds the total submitted charges by the network pharmacy for which the pharmacy is paid.
(d) A pharmacy benefits manager's failure to comply with this section shall be considered an unfair and deceptive trade practice and shall be actionable under Chapter 75 of the General Statutes. Nothing in this subsection shall foreclose other remedies available under law or equity.
"§ 58‑56A‑4. Pharmacy and pharmacist protections.
(a) A pharmacy benefits manager may not charge a fee, or otherwise hold a pharmacist or pharmacy responsible, for costs relating to the adjudication of a claim.
(b) A pharmacy benefits manager may not recoup funds from a pharmacy in connection with claims for which the pharmacy has already been paid without first complying with the requirements under Article 4C of this Chapter, unless the recoupment is otherwise permitted or required by law. No pharmacist or pharmacy shall be penalized or retaliated against for exercising any rights under this Chapter.
(c) This section shall not apply to any licensed group health maintenance organization with an exclusive medical group contract that operates its own pharmacies.
(d) A pharmacy benefits manager's failure to comply with this section shall be considered an unfair and deceptive trade practice and shall be actionable under Chapter 75 of the General Statutes. Nothing in this subsection shall foreclose other remedies available under law or equity."
SECTION 3. The Commissioner of Insurance may adopt rules to implement this act.
SECTION 4. This act becomes effective October 1, 2017, and applies to all contracts entered into, renewed, or amended on or after that date.