NC H534

Establishes mandatory licensure for pharmacy benefits managers (PBMs) operating in North Carolina, with an initial application fee of $2,000 and annual renewal fee of $1,500.

Prohibits PBMs from restricting pharmacies or pharmacists from discussing drug costs with patients, offering delivery services, or selling more affordable alternatives.

Limits copayment charges to the lesser of submitted charges, contracted copayment amount, or cash price; caps claim denial fees to amounts reported on remittance advice or outlined in contracts.

Requires PBMs to establish appeals procedures for maximum allowable cost pricing disputes, with decisions required within 10 calendar days and ability to reverse and rebill claims if appeals are upheld.

Mandates annual reporting of rebates received from pharmaceutical manufacturers and amounts not passed through to insurers; allows penalties of $100-$1,000 per day per prescription drug for violations of maximum allowable cost provisions.