NC S479

Prohibits insurers and pharmacy benefits managers (PBMs) from restricting patients' pharmacy choice, imposing unequal copayments, or requiring mail-order pharmacy use as a condition of coverage, effective October 1, 2025

Creates new licensing and transparency requirements for Pharmacy Services Administrative Organizations (PSAOs) that negotiate contracts on behalf of independent pharmacies, including $200 initial application fee and $150 annual renewal fee, effective October 1, 2026

Requires PBMs to report annually to the Commissioner of Insurance on rebates received, spread pricing amounts, fees collected from pharmacies, and affiliated pharmacy relationships; prohibits PBMs from reimbursing independent pharmacies below acquisition cost

Establishes PBM fiduciary duties to act in good faith for contracted insurers, pass through rebates and discounts, and avoid conflicts of interest; requires 90% of prescription drug rebates to be applied to reduce patient cost-sharing at point of sale, effective January 1, 2027

Extends Medicaid managed care pharmacy reimbursement rates at 100% of fee-for-service methodologies through June 30, 2031, and requires drug manufacturers to notify interested parties of price increases of 15% or more for drugs costing $100+ per 30-day supply