Senate Bill 432 Summary

• Establishes licensure requirements for freestanding birth centers in North Carolina, requiring Commission for the Accreditation of Birth Centers (CABC) accreditation and limiting services to low-risk pregnancies with mandatory ultrasounds and transfer protocols.

• Creates the North Carolina Birth Center Commission with seven members (physicians and midwives) to adopt standards and review license applications, with annual licensing fees of $400 plus $17.50 per birthing room.

• Implements comprehensive regulation of pharmacy benefits managers (PBMs) requiring state licensure ($2,000 initial fee, $1,500 annual renewal) and establishing standards for claims processing, maximum allowable cost pricing, and network participation.

• Prohibits insurers from requiring insured individuals to take drugs with black box warnings and mandates insurers provide immediate coverage for prescription drugs during preauthorization review periods.

• Protects pharmacies and pharmacists by restricting PBM fees to those disclosed in contracts, preventing retroactive claim denials except for fraud, and establishing administrative appeals procedures for maximum allowable cost pricing disputes.