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 […]
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 […]
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 […]
58-56A-20. Pharmacy benefits manager affiliate disclosure; sharing of data. 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. (2021-161, s. 1(b).)
58-56A-21. Claims data provided to health benefit plan. 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 […]
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 […]
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 […]
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 […]
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 […]
58-56A-45. Rules. The Commissioner shall adopt rules to implement the provisions of this Article. (2021-161, s. 1(b).)
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 […]
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 […]
