NC H163

Prohibits pharmacy benefits managers (PBMs) from engaging in "spread pricing" by charging insurers more for drugs than they pay pharmacies, and requires PBMs to reimburse pharmacies at least the national average drug acquisition cost plus a professional dispensing fee

Bans PBMs from charging pharmacies claim adjudication or network participation fees, basing reimbursement on patient outcome metrics, imposing retroactive fees, or redirecting claims to discount card programs

Requires PBMs to file quarterly reports with the Insurance Commissioner starting May 2026 detailing drug acquisition costs, concessions received from manufacturers, and rebates not passed on to insurers

Establishes uniform specialty pharmacy accreditation standards, prohibiting PBMs from requiring multiple accreditations or excluding accredited specialty pharmacies from networks

Strengthens pharmacy audit protections by limiting retail pharmacy audits to once per quarter and capping audited prescriptions at the lesser of 0.1% of annual fills or 50 prescriptions, effective October 1, 2025