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Code · North Carolina · Chapter 58 — Insurance

Part 8.

251 words·~1 min read·/nc/chapter-58/8-2

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

Part 8. Pharmacy Audit Rights.
§ 58-50-400. Definitions.
The following definitions apply in this Part:
(1)Auditing entity. - The responsible party conducting an audit of a pharmacy or the entity conducting an audit of a pharmacy on behalf of a responsible party.
(2)Claim. - A request for reimbursement submitted by a pharmacy or pharmacist to a pharmacy benefits manager for a single fill or refill of any drug, product, or medication for which a prescription is written by a licensed prescriber under applicable State or federal law, or pharmacist-provided service, that has been adjudicated and processed by the pharmacy benefits manager. Each fill or refill shall constitute a separate and distinct claim, regardless of the number of days' supply or quantity dispensed.
(3)Reserved for future codification purposes.
(4)Medication error. - The dispensing of the wrong prescription drug, the dispensing of a prescription to the wrong patient, or the dispensing of a prescription with the wrong directions or patient instructions.
(5)Pharmacist. - An individual licensed to practice pharmacy under Article 4A of Chapter 90 of the General Statutes.
(6)Pharmacy. - An individual or entity holding a valid pharmacy permit pursuant to G.S. 90-85.21 or G.S. 90-85.21A.
(7)Reserved for future codification purposes.
(8)Responsible party. - An insurer offering a health benefit plan or any other entity regulated under this Chapter responsible for payment of claims for healthcare services. (2011-375, s. 1; 2013-379, s. 3; recodified from N.C. Gen. Stat. 90-85.50(a) by 2025-69, s. 5.1(a), (b).)
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