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North CarolinaSB 4792025-2026 SessionSenateWALLET

AN ACT SUPPORTING COMMUNITY RETAIL PHARMACIES AND IMPROVING TRANSPARENCY.

Sponsored By: Jr. Danny Earl Britt (Republican), Amy S. Galey (Republican), Benton G. Sawrey (Republican)

Signed by Governor

COMMERCECOMMUNITY DEVELOPMENTCONSUMER PROTECTIONCONTRACTSCOUNTIESHEALTH SERVICESINSURANCEINSURANCE DEPT

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Bill Overview

Analyzed Economic Effects

12 provisions identified: 9 benefits, 1 costs, 2 mixed.

Fair pay and open pharmacy networks

Beginning October 1, 2025, PBMs must let any properly licensed pharmacy join retail networks on the same terms. PBMs cannot charge network participation fees or require multiple specialty accreditations. Plans that limit participation must give all area pharmacies a written offer at least 60 days before the plan starts. PBMs must pay local pharmacies at least what they pay their own affiliates for the same drug per unit, counting rebates and fees. Insurers cannot cut a pharmacy’s pay because a member chose it, and rebates or incentives must be offered equally for the same volume and terms. If a PBM ends your contract, it still must pay for past, proper claims. Pharmacies may charge a small, disclosed shipping and handling fee for mailed prescriptions. For RFPs issued on or after October 1, 2025, the State considers PBM contract terms that protect local pharmacies, like parity and banning payments below acquisition cost.

Protections for independent pharmacies' pay and buying

For PBM contracts made, renewed, or changed on or after October 1, 2025, a PBM cannot require an independent pharmacy or a pharmacy in a pharmacy desert to take payment below the drug’s acquisition cost. Starting October 1, 2026, a PSAO cannot charge an independent pharmacy different drug prices based on what the pharmacy paid a wholesaler. Also starting October 1, 2026, a PSAO tied to a drug maker or distributor cannot force an independent pharmacy to buy only from that tied company.

Lower drug copays after rebates

Beginning January 1, 2027, your insurer must base copays and coinsurance on the drug’s price after rebates. The price used must be reduced by 90% of all rebates tied to that prescription. By January 1 each year, insurers must certify to the state that they followed this rule. Each day a filing is late counts as a separate violation.

You can use any in-network pharmacy

Beginning October 1, 2025, your plan cannot stop you from choosing any participating pharmacy. Your copay or fees must be the same for the same benefit level. Plans cannot steer you with higher copays or penalties, except in pharmacy deserts or counties under 20,000 people. Plans cannot require mail‑order only. PBM networks must meet or beat Medicare Part D access rules. The state can penalize violators, and people and pharmacies can sue. PBMs also cannot share identifiable prescription data with affiliates in ways HIPAA forbids.

Medicaid drug pay matches fee for service

Prepaid Medicaid plans must use 100% of Medicaid fee‑for‑service methods to pay for ingredient cost and dispensing fees. NADAC plus a professional dispensing fee is the main method for non‑340B retail claims. 340B claims follow the CMS‑approved State Plan. This change is in effect now and ends June 30, 2026.

Stronger guardrails on pharmacy audits

Auditors must give at least 14 days’ notice for on‑site audits and usually review only the last 24 months. They may examine the smaller of 0.1% of fills or 50 fills, with limited exceptions. Pharmacies generally face no more than one audit per year unless fraud is suspected and get 30 days to provide records. Before taking back money, auditors must give a summary with the total amount and a 7‑day window for the recoupment date. Breaking these audit rules is an unfair trade practice for audits on or after January 1, 2026.

New PBM duties and pricing transparency

The law applies all state drug‑coverage and unfair‑trade rules to PBMs, the same as insurers. PBMs must act in the insurer’s best interest, pass through rebates tied to the insurer’s money, and share claims data on request. Starting March 31, 2026, for contracts signed, renewed, or changed on or after October 1, 2025, PBMs that use spread pricing must report each quarter the gap between what they charge and what they pay pharmacies. Insurers must post these reports and share them with any employer customers. The Department of Insurance adopts PBM rules by October 1, 2025.

PBM cost reports and pharmacy tracking

Starting October 1, 2025, PBMs with insurer contracts must file an annual report by May 1 with totals on rebates, spreads between plan and pharmacy payments, affiliate reimbursements, fees, and amounts passed through. These reports are confidential and cannot include personal data. By October 1 each year, the Board of Pharmacy must report statewide pharmacy counts and openings and closures over the past five years.

Drug price reporting and public portal

Beginning January 1, 2026, drug makers must report by January 31 each year any price increase of 15% or more on drugs priced $100 or more for a 30‑day supply. Makers must also report a new drug’s price within 3 days of first sale and share acquisition details within 30 days. The state will build an online portal and, starting January 1, 2027, publish a yearly report on the most used, most costly, and fastest‑rising drugs, and the top manufacturers by average increases. Companies may satisfy reporting through SEC filings, and the state treats submitted data as confidential trade secrets. DHHS enforces the rules and can fine up to $1,000 per day for not reporting.

Licensing and rules for PSAOs

Beginning October 1, 2026, PSAOs must be licensed and pay a $200 initial fee and a $150 annual renewal. PSAOs must give pharmacies copies of contracts and payment schedules within 10 days, pass through PBM remittances on schedule, and may not tie discounts to purchase volume. PSAOs must forward appeal notices quickly, share ownership details with the Department and counterparties, and disclose affiliated purchasing deals. A PSAO that breaks the law pays $500 per day after notice until it complies, and the Commissioner can revoke or refuse renewal.

Licensing and limits for PSAO operations

Beginning October 1, 2026, any PSAO that negotiates for North Carolina pharmacies must be licensed by the Department of Insurance. The Commissioner sets the application and may charge initial and yearly renewal fees. PSAO reports to the Department are confidential, cannot include personal data about insured people, and are not public records. The Insurance Commissioner must adopt PSAO rules by October 1, 2026.

Pharmacies cannot waive your copay

Beginning October 1, 2025, pharmacies and pharmacists cannot waive or discount your copay or coinsurance. Breaking this rule is professional misconduct under state pharmacy law.

Sponsors & Cosponsors

Sponsors

  • Jr. Danny Earl Britt

    Republican • Senate

  • Amy S. Galey

    Republican • Senate

  • Benton G. Sawrey

    Republican • Senate

Cosponsors

  • Paul Newton

    Republican • Senate

  • Lisa S. Barnes

    Republican • Senate

  • Phil Berger

    Republican • Senate

  • Woodson Bradley

    Democratic • Senate

  • Bob Brinson

    Republican • Senate

  • Jim Burgin

    Republican • Senate

  • Jay J. Chaudhuri

    Democratic • Senate

  • Jr. David W. Craven

    Republican • Senate

  • Warren Daniel

    Republican • Senate

  • Bobby Hanig

    Republican • Senate

  • Ralph Hise

    Republican • Senate

  • Mark Hollo

    Republican • Senate

  • Brent Jackson

    Republican • Senate

  • Steve Jarvis

    Republican • Senate

  • Todd Johnson

    Republican • Senate

  • Michael A. Lazzara

    Republican • Senate

  • Tom McInnis

    Republican • Senate

  • Timothy D. Moffitt

    Republican • Senate

  • Brad Overcash

    Republican • Senate

  • Bill Rabon

    Republican • Senate

  • Norman W. Sanderson

    Republican • Senate

  • Vickie Sawyer

    Republican • Senate

  • Eddie D. Settle

    Republican • Senate

Roll Call Votes

All Roll Calls

Yes: 343 • No: 43

House vote • 6/26/2025

SB 479: SCRIPT Act.

Yes: 106 • No: 0 • Other: 10

Senate vote • 6/26/2025

SB 479: SCRIPT Act.

Yes: 42 • No: 0 • Other: 8

Senate vote • 6/19/2025

SB 479: SCRIPT Act.

Yes: 9 • No: 31 • Other: 10

House vote • 6/18/2025

SB 479: SCRIPT Act.

Yes: 96 • No: 12 • Other: 9

Senate vote • 5/7/2025

SB 479: SCRIPT Act.

Yes: 45 • No: 0 • Other: 3

Senate vote • 5/7/2025

SB 479: SCRIPT Act.

Yes: 45 • No: 0 • Other: 3

Actions Timeline

  1. Ch. SL 2025-69

    7/9/2025Senate

  2. Signed by Gov. 7/9/2025

    7/9/2025Senate

  3. Pres. To Gov. 6/30/2025

    6/30/2025Senate

  4. Ratified

    6/30/2025Senate

  5. Ordered Enrolled

    6/26/2025Senate

  6. Conf Report Adopted

    6/26/2025House

  7. Added to Calendar

    6/26/2025House

  8. Conf Com Reported

    6/26/2025House

  9. Conf Report Adopted

    6/26/2025Senate

  10. Placed on Today's Calendar

    6/26/2025Senate

  11. Conf Com Reported

    6/26/2025Senate

  12. Conf Com Appointed

    6/23/2025House

  13. Conf Com Appointed

    6/19/2025Senate

  14. Failed Concur In H Com Sub

    6/19/2025Senate

  15. Placed On Cal For 06/19/2025

    6/18/2025Senate

  16. Special Message Received For Concurrence in H Com Sub

    6/18/2025Senate

  17. Special Message Sent To Senate

    6/18/2025House

  18. Passed 3rd Reading

    6/18/2025House

  19. Passed 2nd Reading

    6/18/2025House

  20. Added to Calendar

    6/18/2025House

  21. Cal Pursuant Rule 36(b)

    6/18/2025House

  22. Reptd Fav

    6/18/2025House

  23. Re-ref Com On Rules, Calendar, and Operations of the House

    6/17/2025House

  24. Reptd Fav Com Substitute

    6/17/2025House

  25. Re-ref to the Com on Health, if favorable, Rules, Calendar, and Operations of the House

    6/16/2025House

Bill Text

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