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PBM Reform
Occasionally, NCAP receives questions from members regarding North Carolina PBM-related laws. The following resource compiles existing PBM statutes, organized by categories, for which inquiries are commonly made. In addition, the resource provides a direct link to the Department of Insurance portal for filing PBM-related complaints.
Contents
Consumer Protections
Anti Gag Clause
§ 58-56A-3
Pharmacy of Choice
§ 58-51-37
§ 58-56A-15
Access to Nonformulary and Restricted Access Prescription Drugs
§ 58‑3‑221
Anti-Steering and Incentivization
§ 58-51-37
Pharmacist and Pharmacy Protections
Network Adequacy and ‘Any Willing Provider’
§ 58-56A-15
Audits, Claims, and Appeals
§ 90‑85.50
§ 58-56A-4
§ 58-56A-21
§ 58-56A-5
§ 90-85.52
§ 90-85.51
Pharmacy Rights to Mail/Ship Patient Meds
§ 58-56A-3
Maximum Allowable Cost Price (MAC)
§ 58-56A-5
340B
§ 58-56A-50
Natural Disaster or State of Emergency
§ 58-3.228
Access to Nonformulary and Restricted Access Prescription Drugs
§ 58‑3‑221
North Carolina Department of Insurance
Licensure of PBMs
§ 58-56A-2
Enforcement and Civil Penalties for Violations
§ 58-56A-25
§ 58-56A-30
Phone: 855-408-1212
Additional Resources
Statutory-related PBM Definitions
§ 58-56A-1
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