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Pharmacy Benefits Manager Provisions

EngrossedCody Huneycutt (R)House2025–2026 Session
AI Generated

This bill regulates pharmacy benefits managers (PBMs) in North Carolina by prohibiting spread pricing (charging insurers more than they pay pharmacies), restricting certain fees and concessions, establishing standards for specialty pharmacy accreditation, clarifying patients' right to choose their pharmacy, and strengthening audit protections for pharmacies. The bill also requires PBMs to report concession data to the Insurance Commissioner.

Arguments in Favor

Supporters argue this bill protects pharmacies from unfair PBM practices that reduce their reimbursement and ability to serve patients, helps patients afford medications by requiring PBMs to pass savings to them through lower out-of-pocket costs, prevents PBMs from restricting access to specialty pharmacies through excessive accreditation requirements, and increases transparency by requiring PBMs to report financial data to regulators. The bill also protects patients' freedom to choose their preferred pharmacy without financial penalties.

Arguments Against

Opponents may argue the bill increases regulatory complexity and compliance costs for PBMs, potentially leading to higher insurance premiums or reduced plan options for consumers. They may contend that restrictions on PBM business practices could limit their ability to negotiate drug prices with manufacturers and manage costs, that detailed reporting requirements could expose proprietary business information, and that the rules could reduce PBM flexibility to innovate in cost-management strategies. Some may also argue the bill's restrictions could ultimately increase healthcare costs.

AI-generated analysis based on bill text. Always verify with official sources at ncleg.gov. This is not legal or political advice.

Sponsors

Cosponsors (31)

Julia Howard
Julia HowardRepublican

Representative · District 77

Chris Humphrey
Chris HumphreyRepublican

Representative · District 12

Ben Moss
Ben MossRepublican

Representative · District 52

Larry Strickland
Larry StricklandRepublican

Representative · District 28

Brian Biggs
Brian BiggsRepublican

Representative · District 70

Jeffrey McNeely
Jeffrey McNeelyRepublican

Representative · District 84

Richard Carver
Richard CarverRepublican

Representative · District 95

Mitchell Setzer
Mitchell SetzerRepublican

Representative · District 89

Charles Miller
Charles MillerRepublican

Representative · District 19

Diane Wheatley
Diane WheatleyRepublican

Representative · District 43

Joe Pike
Joe PikeRepublican

Representative · District 6

Bill Ward
Bill WardRepublican

Representative · District 5

William Brisson
William BrissonRepublican

Representative · District 22

Steve Tyson
Steve TysonRepublican

Representative · District 3

Donna White
Donna WhiteRepublican

Representative · District 26

Shelly Willingham
Shelly WillinghamDemocrat

Representative · District 23

Reece Pyrtle
Reece PyrtleRepublican

Representative · District 65

Paul Scott
Paul ScottRepublican

Representative · District 111

Donnie Loftis
Donnie LoftisRepublican

Representative · District 109

Jerry Branson
Jerry BransonRepublican

Representative · District 59

David Willis
David WillisRepublican

Representative · District 68

Keith Kidwell
Keith KidwellRepublican

Representative · District 79

Mary Harrison
Mary HarrisonDemocrat

Representative · District 61

Eric Ager
Eric AgerDemocrat

Representative · District 114

Allen Chesser
Allen ChesserRepublican

Representative · District 25

Jeff Zenger
Jeff ZengerRepublican

Representative · District 74

Timothy Reeder
Timothy ReederRepublican

Representative · District 9

Jake Johnson
Jake JohnsonRepublican

Representative · District 113

Jennifer Balkcom
Jennifer BalkcomRepublican

Representative · District 117

Grant Campbell
Grant CampbellRepublican

Representative · District 83

Jonathan Almond
Jonathan AlmondRepublican

Representative · District 73

Vote Breakdown (1 roll call)

Final Vote

House Initial PassageApr 29, 2025

On: Second Reading

Passed
106
Yea
9
Nay
0
Not Voting
5
Absent
106 Yea9 Nay
Republican69 Yea·0 Nay
Democrat37 Yea·9 Nay