NC H246

Prohibits pharmacy benefits managers (PBMs) from charging pharmacies fees related to claim adjudication or network participation, and requires reimbursement at or above the national average drug acquisition cost plus a professional dispensing fee.

Bans "spread pricing" where PBMs charge insurers a different price than what they pay pharmacies, and prohibits PBMs from deriving revenue from patients or pharmacies in connection with providing pharmacy benefits management services.

Establishes uniform specialty pharmacy accreditation standards through three recognized bodies (Utilization Review Accreditation Commission, Accreditation Commission for Health Care Inc., and The Joint Commission) and allows accredited pharmacies to dispense specialty drugs.

Clarifies that patients have the right to choose any participating pharmacy without additional costs and requires copayment accumulators to count toward out-of-pocket maximums for non-generic drugs when the patient receives prior authorization or completes step therapy.

Requires PBMs to file quarterly reports with the Commissioner detailing rebates, fees, and wholesale acquisition costs, and strengthens pharmacy audit protections by limiting audits to 25 prescriptions and requiring 14 days' written notice before additional audits.