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Code · North Carolina · Chapter 58 — Insurance

§ 58-56A-15. Pharmacy benefits manager networks.

262 words·~1 min read·/nc/chapter-58/58-56a-15

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§ 58-56A-15. Pharmacy benefits manager networks.
(a)A pharmacy benefits manager shall not deny the right to any properly licensed pharmacist or pharmacy to participate in a retail pharmacy network on the same terms and conditions of other similarly situated participants in the network.
(b)A pharmacist or pharmacy that is a member of a pharmacy service administrative organization that enters into a contract with a health benefit plan issuer or a pharmacy benefits manager on the pharmacy's behalf is entitled to receive from the pharmacy service administrative organization a copy of the contract provisions applicable to the pharmacy, including each provision relating to the pharmacy's rights and obligations under the contract.
(c)Termination of a pharmacy or pharmacist from a pharmacy benefits manager network does not release the pharmacy benefits manager from the obligation to make any payment due to the pharmacy or pharmacist for pharmacist services properly rendered according to the contract. This subsection does not apply in cases of fraud, waste, and abuse.
(d)A pharmacy benefits manager shall not require multiple specialty pharmacy accreditations as a prerequisite for participation in a retail pharmacy network that dispenses specialty drugs nor exclude a specialty pharmacy from the right to participate in the network.
(e)A pharmacy benefits manager shall not charge a pharmacist or pharmacy a fee related to participation in a retail pharmacy network.
(f)A pharmacy benefits manager pharmacy provider network shall meet or exceed the Medicare Part D program standards for convenient access to network pharmacies under 42 C.F.R. § 423.120. (2021-161, s. 1(b); 2025-69, s. 4.2.)
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