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Primary Sponsor

Last Action

Ref To Com On Rules and Operations of the Senate2025-04-30

Vote Breakdown

Plain Language Summary

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.