§ 135-48.36. Pharmacy benefits manager contracts.

252 words·~1 min read·/nc/chapter-135/135-48-36

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

The Executive Administrator shall consider incorporating the following items into a request for proposal for a pharmacy benefits manager for the Plan:

(1)Allowing the Plan's pharmacy benefits managers to provide a monetary advantage to pharmacies in North Carolina neighborhoods, communities, and counties that are underserved by pharmacies.

(2)Requiring the Plan's pharmacy benefits managers to annually report all of the information required in G.S. 58-56A-22 to the State Treasurer, Commissioner of Insurance, and Joint Legislative Oversight Committee on Health and Human Services no later than May 1 of each year.

(3)Preventing the Plan's pharmacy benefits managers from contractually requiring independent pharmacies to accept reimbursement for a drug, device, or pharmacy service in an amount that is less than the acquisition cost of the drug, device, or pharmacy service.

(4)Requiring the Plan and the Plan's pharmacy benefits managers to adhere to the coverage requirements of G.S. 58-56A-55.

(5)Requiring the Plan's pharmacy benefits managers to act as a fiduciary in accordance with G.S. 58-56A-21.

(6)Requiring the Plan and the Plan's pharmacy benefits managers to adhere to the pharmacy of choice provisions of G.S. 58-51-37.

(7)Requiring the Plan's pharmacy benefits managers to meet or exceed the Medicare Part D program standards for convenient access to network pharmacies under 42 C.F.R. § 423.120.

(8)Requiring the Plan's pharmacy benefits managers to reimburse affiliated and non-affiliated pharmacies on the same terms.

(9)Adhering to the cost-sharing consumer protection provisions of G.S. 58-3-182. (2025-69, s. 10(a).)