Senate Bill 257 Summary

• Requires pharmacy benefits managers (PBMs) to obtain a license from the North Carolina Department of Insurance with an initial application fee of $2,000 and annual renewal fee of $1,500.

• Prohibits PBMs from penalizing pharmacies or pharmacists for discussing prescription drug costs with patients or selling lower-priced alternatives.

• Establishes maximum allowable cost pricing standards requiring PBMs to review and adjust drug prices at least every seven business days and provide pharmacies with an appeals process.

• Restricts PBMs from charging copayments exceeding submitted pharmacy charges and prohibits retroactive claim denials except in cases of fraud, double payment, or non-rendered services.

• Creates penalties of $100 to $1,000 per day for violations and requires the Department of Insurance to establish a stakeholder workgroup by December 1, 2021 to recommend a unified specialty pharmacy accreditation process.