Article 56A.
Pharmacy Benefits Management.
§ 58-56A-1. Definitions.
The following definitions apply in this Article:
(1) 340B contract pharmacy. - Any pharmacy under contract with a 340B covered entity to dispense drugs on behalf of the 340B covered entity.
(2) 340B covered entity. - Any entity defined in 42 U.S.C. § 256b(a)(4)(A), 42 U.S.C. § 256b(a)(4)(C), 42 U.S.C. § 256b(a)(4)(D), 42 U.S.C. § 256b(a)(4)(E), 42 U.S.C. § 256b(a)(4)(I), 42 U.S.C. § 256b(a)(4)(J), 42 U.S.C. § 256b(a)(4)(K), 42 U.S.C. § 256b(a)(4)(N), or 42 U.S.C. § 256b(a)(4)(O).
(3) Claim. - A request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or device.
(4) Claims processing service. - The administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include either or both of the following activities:
a. Receiving payments for pharmacist services.
b. Making payments to pharmacists or pharmacies for pharmacist services.
(4b) Reserved for future codification purposes.
(5) Health benefit plan. - As defined in G.S. 58-3-167.
(5a) High-deductible health plan. - As defined under the Internal Revenue Code.
(6) Insured. - An individual covered by a health benefit plan.
(7) Insurer. - As defined in G.S. 58-3-167.
(8) Maximum allowable cost list. - A listing of generic or multiple source drugs used by a pharmacy benefits manager to set the maximum allowable cost on which reimbursement of a pharmacy is made.
(9) Maximum allowable cost price. - The maximum amount that a pharmacy benefits manager will reimburse a pharmacy for the cost of generic or multiple source prescription drugs, medical products, or devices.
(10) Out-of-pocket costs. - With respect to the acquisition of a drug, the amount to be paid by the insured under the plan or coverage, including any cost-sharing, copayment, coinsurance, or deductible.
(11) Pharmacist. - A person licensed to practice pharmacy under Article 4A of Chapter 90 of the General Statutes.
(12) Pharmacist services. - Products, goods, or services provided as a part of the practice of pharmacy.
(13) Pharmacy. - As defined in G.S. 90-85.3(q).
(14) Pharmacy benefits manager. - An entity who contracts with a pharmacy on behalf of an insurer or third-party administrator to administer or manage prescription drug benefits to perform any of the following functions:
a. Negotiating rebates with manufacturers for drugs paid for or procured as described in this Article.
b. Processing claims for prescription drugs or medical supplies or providing retail network management for pharmacies or pharmacists.
c. Paying pharmacies or pharmacists for prescription drugs or medical supplies.
(15) Pharmacy benefits manager affiliate. - A pharmacy or pharmacist that directly or indirectly, through one or more intermediaries, owns or controls or is owned or controlled by a pharmacy benefits manager.
(16) Pharmacy service administrative organization (PSAO). - An organization that assists community pharmacies and pharmacy benefits managers or third-party payors in achieving administrative efficiencies, including contracting and payment efficiencies.
(16a) Section 223. - Section 223 of the Internal Revenue Code or its equivalent.
(16b) Specialty drug. - Any of the following prescription medications:
a. A medication that is subject to restricted distribution by the United States Food and Drug Administration.
b. A medication used to treat complex or chronic conditions that requires special handling, provider coordination, or patient education.
c. A medication classified as a specialty drug as determined by a health benefit plan.
(16c) Specialty pharmacy. - A pharmacy accredited as a specialty pharmacy by a nationally recognized, independent accrediting organization that evaluates a pharmacy's compliance with quality, safety, and service standards for handling, dispensing, and managing specialty drugs. The accreditation may be issued by the Utilization Review Accreditation Commission (URAC), the Accreditation Commission for Health Care (ACHC), the National Association of Boards of Pharmacy (NABP), the Joint Commission, or their successors.
(17) Third-party administrator. - As defined in G.S. 58-56-2. (2014-120, s. 20(a); 2017-116, s. 1; 2021-161, s. 1(b); 2025-69, s. 3.1(a).)
§ 58-56A-2. Licensure.
(a) A person or organization may not establish or operate as a pharmacy benefits manager for health benefit plans in this State without obtaining a license from the Commissioner of the Department of Insurance.
(b) The Commissioner shall develop an application for licensure to operate in this State as a pharmacy benefits manager and may charge an initial application fee of two thousand dollars ($2,000) and an annual renewal fee of one thousand five hundred dollars ($1,500). The pharmacy benefits manager application form must collect only the following information:
(1) The name, address, and telephone contact number of the pharmacy benefits manager.
(2) The name and address of the pharmacy benefits manager's agent for service of process in this State.
(3) The name and address of each person with management or control over the pharmacy benefits manager.
(4) The name and address of each person with a beneficial ownership interest in the pharmacy benefits manager.
(5) Either (i) a signed statement that, to the best of the applicant's knowledge, no officer with management or control of the pharmacy benefits manager has been convicted of a felony or has violated any requirement of State or federal law applicable to pharmacy benefits management or (ii) a description of any felony or any violation of any requirement of State or federal law applicable to pharmacy benefits management committed by any officer with management or control of the pharmacy benefits manager.
(c) Unless otherwise provided for in this Article, an applicant or a pharmacy benefits manager that is licensed to conduct business in the State shall file a notice describing any material modification of the information required under this section.
(d) The Commissioner shall adopt rules establishing the licensing and reporting requirements of pharmacy benefits managers consistent with the provisions of this Article. (2021-161, s. 1(b).)
§ 58-56A-3. Consumer protections.
(a) A pharmacy or pharmacist shall have the right to provide an insured information regarding the amount of the insured's cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing any information described in this section or for selling a lower-priced drug to the insured if one is available.
(b) A pharmacy benefits manager shall not, through contract, prohibit a pharmacy from offering and providing direct and limited delivery services to an insured as an ancillary service of the pharmacy, as delineated in the contract between the pharmacy benefits manager and the pharmacy.
(b1) A pharmacy benefits manager shall not prohibit a pharmacist or pharmacy from charging a minimal shipping and handling fee to the insured for a mailed or delivered prescription if the pharmacist or pharmacy discloses all of the following to the insured before delivery:
(1) The fee will be charged.
(2) The fee may not be reimbursed by the health benefit plan, insurer, or pharmacy benefits manager.
(3) Repealed by Session Laws 2025-69, s. 4.1, effective October 1, 2025, and applicable to contracts entered into, renewed, or amended on or after that date.
(c) A pharmacy benefits manager shall not charge, or attempt to collect from, an insured a copayment that exceeds the total submitted charges by the network pharmacy.
(c1) When calculating an insured's contribution to any out-of-pocket maximum, deductible, copayment, coinsurance, or other applicable cost-sharing requirement, the insurer or pharmacy benefits manager shall include any amounts paid by the insured, or on the insured's behalf, for a prescription that is either:
(1) Without an AB-rated generic equivalent.
(2) With an AB-rated generic equivalent if the insured has obtained authorization for the drug through any of the following:
a. Prior authorization from the insurer or pharmacy benefits manager.
b. A step therapy protocol.
c. The exception or appeal process of the insurer or pharmacy benefits manager.
This subsection shall not apply to an insured covered by a high deductible health plan, as that term is defined in section 223 of the Internal Revenue Code, if its application would render the insured ineligible for a health savings account under section 223 unless (i) the insured has satisfied the minimum deductible under section 223 or (ii) the prescription qualifies as preventive care under section 223.
(c2) For purposes of this section, the term "generic equivalent" means a drug that has an identical amount of the same active ingredients in the same dosage form; meets applicable standards of strength, quality, and purity according to the United States Pharmacopeia or other nationally recognized compendium; and which, if administered in the same amount, would provide comparable therapeutic effects. The term "generic equivalent" does not include a drug that is listed by the United States Food and Drug Administration as having unresolved bioequivalence concerns according to the Administration's most recent publication of approved drug products with therapeutic equivalence evaluations.
(c3) G.S. 58-3-182 applies to pharmacy benefits managers when calculating an insured's out-of-pocket cost for a covered prescription drug.
(d) Any contract for the provision of a network to deliver health care services between a pharmacy benefits manager and insurer shall be made available for review by the Department.
(e) Repealed by Session Laws 2021-161, s. 1(b), effective October 1, 2021, and applicable to any contracts entered into, renewed, or amended on or after that date.
(f) G.S. 58-51-37 shall apply to pharmacy benefits managers that contract with an insurer in this State in the same manner as it applies to an insurer. (2017-116, s. 2; 2021-161, s. 1(b); 2023-134, s. 30.10; 2025-69, s. 4.1.)
§ 58-56A-4. Pharmacy and pharmacist protections.
(a) A pharmacy benefits manager may only charge fees or otherwise hold a pharmacy responsible for a fee relating to the adjudication of a claim if the fee is reported on the remittance advice of the adjudicated claim or is set out in contract between the pharmacy benefits manager and the pharmacy. No fee or adjustment for the receipt and processing of a claim, or otherwise related to the adjudication of a claim, shall be charged without a justification on the remittance advice or as set out in contract and agreed upon by the pharmacy or pharmacist for each adjustment or fee. This section shall not apply with respect to claims under an employee benefit plan under the Employee Retirement Income Security Act of 1974 or Medicare Part D.
(b) Nothing in this Article shall abridge the right of a pharmacist to refuse to fill or refill a prescription if the pharmacist believes it would be harmful to the patient or is not in the patient's best interest, or if there is a question to the validity of the prescription.
(c) A pharmacy or pharmacist shall not be prohibited by a pharmacy benefits manager from dispensing any prescription drug, including specialty drugs dispensed by a credentialed and accredited pharmacy, allowed to be dispensed under a license to practice pharmacy under Article 4A of Chapter 90 of the General Statutes.
(d) A pharmacy benefits manager shall not penalize or retaliate against a pharmacist or pharmacy for exercising rights provided under this Article. This subsection does not apply to breach of contract between a pharmacy and a pharmacy benefits manager.
(e) A claim for pharmacist services may not be retroactively denied or reduced after adjudication of the claim unless any of the following apply:
(1) The original claim was submitted fraudulently.
(2) The original claim payment was incorrect because the pharmacy or pharmacist had already been paid for the pharmacist services.
(3) The pharmacist services were not rendered by the pharmacy or pharmacist.
(4) The adjustments were agreed to by the pharmacy or pharmacist.
(5) The adjustments were part of an attempt to limit overpayment recovery efforts by a pharmacy benefits manager.
(f) Nothing in this section shall be construed to limit overpayment recovery efforts by a pharmacy benefits manager.
(g) No pharmacy benefits manager contract may require, either, directly or indirectly or through a pharmacy services administration organization, an independent pharmacy, as defined in G.S. 58-51-37, or any pharmacy in a pharmacy desert, as defined in G.S. 58-51-37, to accept reimbursement for providing a covered prescription drug, device, or service at a rate less than the acquisition cost for the covered drug, device, or service. A violation of this section is an unfair trade practice under Article 63 of this Chapter and under G.S. 75-1.1 and is subject to all of the enforcement and penalty provisions of an unfair trade practice under this Chapter and under Article 1 of Chapter 75 of the General Statutes. (2017-116, s. 2; 2021-161, s. 1(b); 2025-69, s. 3.2(a).)
§ 58-56A-5. Maximum allowable cost price.
(a) In order to place a prescription drug on the maximum allowable cost price list, the drug must be available for purchase by pharmacies in North Carolina from national or regional wholesalers, must not be obsolete, and must meet one of the following conditions:
(1) The drug is listed as "A" or "B" rated in the most recent version of the United States Food and Drug Administration's Approved Drug Products with Therapeutic Equivalence Evaluations, also known as the Orange Book.
(2) The drug has a "NR" or "NA" rating, or a similar rating, by a nationally recognized reference.
(b) A pharmacy benefits manager shall adjust or remove the maximum allowable cost price for a prescription drug to remain consistent with changes in the national marketplace for prescription drugs. A review of the maximum allowable cost prices for removal or modification shall be completed by the pharmacy benefits manager at least once every seven business days, and any removal or modification shall occur within seven business days of the review. A pharmacy benefits manager shall provide a means by which the contracted pharmacies may promptly review current prices in an electronic, print, or telephonic format within one business day of the removal or modification.
(c) A pharmacy benefits manager shall ensure that dispensing fees are not included in the calculation of maximum allowable cost price.
(d) A pharmacy benefits manager shall establish an administrative appeals procedure by which a contracted pharmacy or pharmacist, or a designee, may appeal the provider's reimbursement for a prescription drug subject to maximum allowable cost pricing if the amount of reimbursement for the drug is less than the net amount that the network provider paid to the suppliers of the drug. The reasonable administrative appeal procedure must include all of the following:
(1) A dedicated telephone number and email address or website for the purpose of submitting administrative appeals.
(2) The ability to submit an administrative appeal regarding the pharmacy benefits plan or program directly to the pharmacy benefits manager or through a pharmacy service administrative organization if the pharmacy service administrative organization has a contract with the pharmacy benefits manager that allows for the submission of appeals.
(3) No less than 10 calendar days after the applicable prescription fill date to file an administrative appeal.
(4) A period of no more than 10 calendar days after receipt of notice of the filing of the administrative appeal by the pharmacy benefits manager for a decision to be made on the appeal.
(5) A requirement that if an appeal is upheld, then, within 10 calendar days of the decision, the pharmacy benefits manager shall take all of the following actions:
a. Notify the appellant of the decision.
b. Apply the change in the maximum allowable cost effective as of the date the appeal was resolved and make the change effective for all similarly situated pharmacies or pharmacists, as defined by the payor subject to the Maximum Allowable Cost list.
c. Permit the appellant to reverse and rebill the claim that was appealed.
(6) A requirement that if the appeal is denied, then, within 10 calendar days of the decision, the pharmacy benefits manager shall notify the appellant of the decision and provide all of the following information:
a. The reason for denial.
b. The National Drug Code number for the prescription drug that is the subject of the appeal.
c. The names of the national or regional pharmaceutical wholesalers operating in the State. (2014-120, s. 20(a); 2021-161, s. 1(b).)
§ 58-56A-6. Spread pricing reports.
(a) Beginning March 31, 2026, and quarterly thereafter, any pharmacy benefits manager that charges an insurer offering a health benefit plan a price for a prescription drug that differs from the amount the pharmacy benefits manager directly or indirectly pays the pharmacy or pharmacist for providing pharmacist services under that same health benefit plan shall report the aggregate difference between the price charged the insurer and the price paid to the pharmacy or pharmacist for each drug where there is a difference in price.
(b) Any insurer who receives a spread pricing report from a pharmacy benefits manager shall make that report available on its website and to any employers who have purchased a health benefit plan from the insurer.
(c) Any pharmacy benefits manager who (i) is obligated to make a report under subsection (a) of this section and (ii) is in a contractual relationship with an employer who has purchased a health benefit plan from an insurer shall submit the report directly to the employer. (2025-69, s. 3.5(a).)
§ 58-56A-10: Recodified as G.S. 58-56A-30. (2015-273, s. 2; 2016-78, s. 6.3.)
§ 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.)
§ 58-56A-20. Pharmacy benefits manager affiliates.
(a) A pharmacy benefits manager shall not, in any way that is prohibited by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), transfer or share records relative to prescription information containing patient-identifiable and prescriber-identifiable data to a pharmacy benefits manager affiliate.
(b) A pharmacy benefits manager shall not reimburse a pharmacy or pharmacist in this State an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for providing the same pharmacist services or same prescription drug. In determining the amount of the reimbursement for the purposes of this section, the amount shall be calculated on a per-unit basis using the same generic product identifier or generic code number and shall reflect all drug manufacturer's rebates, all direct and indirect administrative fees, and any other cost-savings or discounts that may be given related to the drug or services. A violation of this subsection is an unfair trade practice under Article 63 of this Chapter and under G.S. 75-1.1 and is subject to all of the enforcement and penalty provisions of an unfair trade practice under this Chapter and under Article 1 of Chapter 75 of the General Statutes. (2021-161, s. 1(b); 2025-69, s. 6.1.)
§ 58-56A-21. Duties owed to contracted insurers.
(a) Fiduciary Duty. - A pharmacy benefits manager has a fiduciary duty to act in good faith and fair dealing in the performance of all of its contractual duties, including all of the following:
(1) Controlling costs.
(2) Acting in the best interest of the insurers and health benefit plans offered by the insurers with which the pharmacy benefits manager has a contract.
(3) Acting with prudence and passing through any rebates or discounts the pharmacy benefits manager received related to covered benefits bought and paid for with the contracted insurer's assets or funds.
(4) Avoiding self-dealing and conflicts of interest.
(b) Claims Data Requests. - Upon the request of an insurer offering a health benefit plan that contracts with a pharmacy benefits manager, the pharmacy benefits manager shall provide the insurer with claims data that reflects the total amount the insurer paid to the pharmacy benefits manager under the health benefit plan for a specified outpatient prescription drug, including the ingredient cost and the dispensing fee. The pharmacy benefits manager shall also provide the cost that it paid for the specified outpatient prescription drug, including the ingredient cost and the dispensing fee. (2021-161, s. 1(b); 2025-69, s. 3.4.)
§ 58-56A-22. Reporting requirements for transparency.
(a) Reports to Commissioner. - No later than May 1 of every year, all pharmacy benefits managers shall report to the Commissioner all of the following information regarding prescription drug benefits specific to insurers within the State with which a pharmacy benefits manager has a contract:
(1) The aggregate amount of the rebates that the pharmacy benefits manager received from all drug manufacturers or whole distributers by therapeutic category of prescription drugs. In reporting the aggregate amount of the rebates, the pharmacy benefits manager shall include any utilization discounts it receives from a manufacturer or wholesale distributor.
(2) The aggregated amount of difference between the amount paid by the health benefit plan for prescription drugs and the aggregated amount paid to pharmacies for claims paid under the health benefit plan, including point-of-sale and retroactive charges.
(3) The spread between aggregate amount paid to pharmacies for prescription drugs and the aggregated amount charged to insurers for prescription drugs.
(4) A list of all pharmacies that are under common control or ownership of the pharmacy benefits manager.
(5) A pharmacy benefits manager that is affiliated with a retail pharmacy shall provide the aggregated amount of any differences between what the pharmacy benefits manager reimburses or charges affiliated retail pharmacies and what it reimburses or charges non-affiliated retail pharmacies.
(6) The aggregate amount of all fees or other assessments, including point-of-sale and retroactive charges, that are imposed on, or collected from, contracted, preferred, or in-network pharmacies. Retroactive charges shall not include any funds recouped from an audit conducted under Part 8 of Article 50 of this Chapter.
(7) The aggregate amount of rebates and fees that were passed on to either the insurer with which the pharmacy benefits manager is contracted or an insured at the point-of-sale of a prescription drug.
(8) The highest, lowest, and mean aggregate percentages for retained rebates by the pharmacy benefits manager.
(b) Confidentiality of Data. - Information contained in a report required under this section shall not reveal any personally identifiable information of any insured. Information contained in this report is not considered a public record under Chapter 132 of the General Statutes or under G.S. 58-2-100 and is confidential and privileged. (2025-69, s. 3.1(b).)
§ 58-56A-25. Enforcement.
(a) The Commissioner may make an examination of the affairs of any pharmacy benefits manager pursuant to the services that it provides for an insurer or a health benefit plan that are relevant to determining if the pharmacy benefits manager is in compliance with this Article. When making an examination, the Commissioner may retain attorneys, independent actuaries, independent certified public accountants, or other professionals and specialists as examiners. The pharmacy benefits manager shall bear the cost of retaining those persons.
(b) Pending, during, and after the examination of any pharmacy benefits manager, the Commissioner shall not make public the information or data acquired, and the information or data acquired during an examination is considered proprietary and confidential and is not a public record under Chapter 132 of the General Statutes.
(c) Violations of this Article are subject to the penalties under G.S. 58-56A-30. After notice and hearing, a pharmacy benefits manager may also be subject to revocation of, or a refusal to renew, a license to operate in this State as a result of violations of this Article. (2021-161, s. 1(b).)
§ 58-56A-30. Civil penalties for violations; administrative procedure.
(a) Whenever the Commissioner has reason to believe that a pharmacy benefits manager has violated any of the provisions of this Article with such frequency as to indicate a general business practice, the Commissioner may, after notice and opportunity for a hearing, proceed under the appropriate subsections of this section.
(b) If, under subsection (a) of this section, the Commissioner finds a violation of this Article, the Commissioner may order the payment of a monetary penalty or petition the Superior Court of Wake County for an order directing payment of restitution as provided in subsections (d) and (e) of this section, or both. Each day during which a violation occurs constitutes a separate violation.
(c) If the Commissioner orders the payment of a monetary penalty pursuant to subsection (b) of this section, the penalty shall not be less than one hundred dollars ($100.00) nor more than one thousand dollars ($1,000) per day for each prescription drug resulting from the pharmacy benefit manager's failure to comply with G.S. 58-56A-5. In determining the amount of the penalty, the Commissioner shall consider the degree and extent of harm caused by the violation, the amount of money that inured to the benefit of the violator as a result of the violation, whether the violation was committed willfully, and the prior record of the violator in complying or failing to comply with laws, rules, or orders applicable to the violator. The clear proceeds of the penalty shall be remitted to the Civil Penalty and Forfeiture Fund in accordance with G.S. 115C-457.2. Payment of the civil penalty under this section shall be in addition to payment of any other penalty for a violation of the criminal laws of this State.
(d) Upon petition of the Commissioner to the court pursuant to subsection (b) of this section, the court may order the pharmacy benefits manager who committed a violation under this Article to make restitution in an amount that would make whole any pharmacist harmed by the violation. The petition may be made at any time and also in any appeal of the Commissioner's order.
(e) Upon petition of the Commissioner to the court pursuant to subsection (b) of this section, the court may order the pharmacy benefits manager who committed a violation under this Article to make restitution to the Department for expenses under subsection (f) of this section, incurred in the investigation, hearing, and any appeals associated with the violation in such amount that would reimburse the agency for the expenses. The petition may be made at any time and also in any appeal of the Commissioner's order.
(f) The Commissioner may contract with consultants and other professionals with relevant expertise as necessary and appropriate to conduct investigation, hearing, and appeals activities as provided in this section. These contracts shall not be subject to G.S. 114-2.3, G.S. 147-17, or Articles 3, 3C, and 8 of Chapter 143 of the General Statutes, together with rules and procedures adopted under those Articles concerning procurement, contracting, and contract review.
(g) Nothing in this section prevents the Commissioner from negotiating a mutually acceptable agreement with any pharmacy benefits manager as to any civil penalty or restitution.
(h) Unless otherwise specifically provided for, all administrative proceedings under this Article are governed by Chapter 150B of the General Statutes. Appeals of the Commissioner's orders under this section shall be governed by G.S. 58-2-75. (2015-273, s. 2; 2016-78, s. 6.3; 2021-161, s. 1(b).)
§ 58-56A-45. Rules.
The Commissioner shall adopt rules to implement the provisions of this Article. (2021-161, s. 1(b).)
§ 58-56A-50. Contracts with 340B covered entities.
(a) A contract entered into between a pharmacy benefits manager and a 340B covered entity's pharmacy or between a pharmacy benefits manager and a 340B contract pharmacy shall not do any of the following:
(1) Restrict access to a pharmacy network or adjust 340B drug reimbursement rates based on whether a pharmacy dispenses drugs under the 340B drug discount program.
(2) Assess any additional, or vary the amount of any, fees, chargebacks, or other adjustments on the basis of a drug being dispensed under the 340B drug discount program or a pharmacy's status as a 340B covered entity or a 340B contract pharmacy. This section does not prevent adjustments to correct errors or overpayments resulting from an adjudicated claim.
(b) No pharmacy benefits manager making payments pursuant to a health benefit plan shall discriminate against a 340B covered entity or a 340B contract pharmacy in a manner that prevents or interferes with an enrollee's choice to receive a prescription drug from an in-network 340B covered entity or an in-network 340B contract pharmacy.
(c) The provisions of G.S. 58-51-37 shall apply to pharmacy benefits managers with respect to 340B covered entities and 340B contract pharmacies.
(d) Any provision of a contract entered into between a pharmacy benefits manager and a 340B covered entity or 340B contract pharmacy that is contrary to this section is unenforceable. (2021-161, s. 1(b).)
§ 58-56A-55. Health benefit plan requirements applicable.
(a) All requirements relating to the coverage of prescription drugs and pharmacy services under this Chapter that apply applicable to health benefit plans are applicable to a pharmacy benefits manager managers in the same way they are applicable to an insurer.
(b) Article 63 of this Chapter, Unfair Trade Practices, is applicable to a pharmacy benefits manager in the same manner as it is applicable to an insurer. (2025-37, ss. 5.2(d), 7.2(d); 2025-69, s. 3.3.)