NC H643

Creates a reference pricing system for prescription drugs in North Carolina by establishing maximum rates based on prices from Canadian provincial drug programs and wholesale acquisition costs.

Requires the State Treasurer to identify the 250 most costly prescription drugs for State Health Plan members annually by June 1, with the Commissioner publishing referenced rates by July 1 each year.

Referenced rates are calculated as the lowest cost among Ontario, Quebec, British Columbia, and Alberta drug pricing sources, plus wholesale acquisition cost; if drugs are not listed in those sources, the Canadian Patented Medicine Prices Review Board ceiling price applies.

Allows ERISA health plans to voluntarily elect to participate in the referenced pricing system by notifying the Commissioner by October 1 each year; all other health benefit plans and state entities must comply with the referenced rate caps.

Requires savings from referenced pricing to be reported annually to the Commissioner and used to reduce costs to insured individuals; violations carry maximum fines of $1,000 per transaction, with manufacturers refusing good faith negotiation subject to Attorney General reporting.