Chapter 58

(a) A pharmacy benefits manager shall not, in any way that is prohibited by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), transfer or share records relative to prescription information containing patient-identifiable and prescriber-identifiable data to …

(a) Fiduciary Duty. - A pharmacy benefits manager has a fiduciary duty to act in good faith and fair dealing in the performance of all of its contractual duties, including all of the following: (1) Controlling costs. (2) Acting in the best interest of the insurers and health bene…

(a) Reports to Commissioner. - No later than May 1 of every year, all pharmacy benefits managers shall report to the Commissioner all of the following information regarding prescription drug benefits specific to insurers within the State with which a pharmacy benefits manager has…

(a) The Commissioner may make an examination of the affairs of any pharmacy benefits manager pursuant to the services that it provides for an insurer or a health benefit plan that are relevant to determining if the pharmacy benefits manager is in compliance with this Article. Whe…

(a) A pharmacy or pharmacist shall have the right to provide an insured information regarding the amount of the insured's cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing any information descr…

(a) Whenever the Commissioner has reason to believe that a pharmacy benefits manager has violated any of the provisions of this Article with such frequency as to indicate a general business practice, the Commissioner may, after notice and opportunity for a hearing, proceed under …

(a) A pharmacy benefits manager may only charge fees or otherwise hold a pharmacy responsible for a fee relating to the adjudication of a claim if the fee is reported on the remittance advice of the adjudicated claim or is set out in contract between the pharmacy benefits manager…

The Commissioner shall adopt rules to implement the provisions of this Article. (2021-161, s. 1(b).)

(a) In order to place a prescription drug on the maximum allowable cost price list, the drug must be available for purchase by pharmacies in North Carolina from national or regional wholesalers, must not be obsolete, and must meet one of the following conditions: (1) The drug is …

(a) A contract entered into between a pharmacy benefits manager and a 340B covered entity's pharmacy or between a pharmacy benefits manager and a 340B contract pharmacy shall not do any of the following: (1) Restrict access to a pharmacy network or adjust 340B drug reimbursement …

(a) All requirements relating to the coverage of prescription drugs and pharmacy services under this Chapter that apply applicable to health benefit plans are applicable to a pharmacy benefits manager managers in the same way they are applicable to an insurer. (b) Article 63 of t…

(a) Beginning March 31, 2026, and quarterly thereafter, any pharmacy benefits manager that charges an insurer offering a health benefit plan a price for a prescription drug that differs from the amount the pharmacy benefits manager directly or indirectly pays the pharmacy or phar…

The following definitions apply in this Article: (1) Reserved for future codification purposes. (2) Independent pharmacy. - As defined in G.S. 58-51-37. (3) Insured. - An individual covered by a health benefit plan. (4) Pharmacy. - As defined in G.S. 58-51-37. (5) Pharmacy benefi…

(a) To the Department. - Prior to licensure under this Article and within 10 calendar days of any material change to that disclosure, each PSAO shall provide a written disclosure of ownership to the Department. (b) To Independent Pharmacies, PBMs, and Third-Party Payers. - Prior …

(a) Negotiated Terms. - A PSAO-pharmacy contract shall include a requirement that the PSAO provide to the pharmacy a copy of any contract, amendment, payment schedule, or reimbursement rate within 10 calendar days after the execution of, or amendment to, a contract that the PSAO …

A PSAO shall not discriminate on the price of drugs sold to an independent pharmacy based on the price of drugs purchased from a wholesale distributor of the drug. (2025-69, s. 2.1.)

(a) Prohibitions. - A PSAO that owns or is owned by, in whole or in part, any entity that manufactures, sells, or distributes prescription drugs, biological products, or medical devices shall not, as a condition of entering into a PSAO-pharmacy contract, require that the independ…

(a) Disputes. - If there is a dispute between an independent pharmacy and a PBM or third-party payer, then a PSAO which has entered into a PSAO-pharmacy contract with that independent pharmacy shall ensure and facilitate timely communication between the pharmacy and the PBM or th…

(a) Financial Penalty. - Any PSAO that fails to comply with the provisions of this Article, as determined by the Commissioner, shall pay a penalty of five hundred dollars ($500.00) per day from the day the Commissioner notifies the PSAO of noncompliance until the Commissioner det…

(a) Licensure Requirement. - No pharmacy services administrative organization that negotiates with PBMs, third-party payers, or both on behalf of any pharmacy in this State shall operate without obtaining a license from the Department. (b) Application. - The Commissioner shall de…

The Commissioner of Insurance is authorized to adopt rules, temporary or otherwise, regarding the administration of this Article. (2025-69, s. 2.2(a).)

All credit life insurance, all credit accident and health insurance, all credit property insurance, all credit insurance on credit card balances, all family leave credit insurance, and all credit unemployment insurance written in connection with direct loans, consumer credit inst…

Credit life insurance and credit accident and health insurance shall be issued only in the following forms: (1) Individual policies of life insurance issued to debtors on the term plan; (2) Individual policies of accident and health insurance issued to debtors on a term plan or d…

(a) Single interest or dual interest physical damage insurance may be written on nonfleet private passenger motor vehicles, as defined in G.S. 58-40-10, that are used as collateral for loans made under Article 15 of Chapter 53 of the General Statutes. Automobile physical damage i…

(a) Credit card facilities may be used for the solicitation, negotiation, or payment of premiums for credit insurance on the unpaid balance of any credit card account pursuant to G.S. 58-3-145. Solicitation or negotiation for credit insurance on credit card account balances may n…

(a) Beginning September 1, 2018, and every third year thereafter, the Commissioner shall prescribe a minimum incurred loss ratio standard requirement to develop a premium rate reasonable in relation to the benefits provided by credit unemployment insurance coverage. This minimum …

(a) Definitions. - As used in this section: (1) "Foster child" means a minor (i) over whom a guardian has been appointed by the clerk of superior court of any county in North Carolina; or (ii) the primary or sole custody of whom has been assigned by order of a court of competent …

(a) Credit Life Insurance. - (1) The amount of credit life insurance shall not exceed the amount of unpaid indebtedness as it exists from time to time, less any unearned interest or finance charges; provided, however, that if the amount of credit insurance is based on a predeterm…

Except as otherwise provided in this section, the term of any credit life insurance or credit accident and health insurance shall, subject to acceptance by the insurer, commence on the date when the debtor becomes obligated to the creditor, except that, where a group policy provi…

(a) All individual credit insurance sold shall be evidenced by an individual policy. All group insurance sold where any part of the premium is paid by the debtors or by the creditors from identifiable charges collected from the insured debtors shall be evidenced by a certificate …

(a) All forms of policies, certificates of insurance, notices of proposed insurance, endorsements and riders intended for use in this State shall be filed with the Commissioner. (b) The Commissioner shall, within 90 days after the filing of any such policies, certificates of insu…

(a) Benefits provided by credit life, credit accident and health and credit unemployment insurance written under this Article shall be reasonable in relation to the premium charge. This requirement is conclusively presumed to be satisfied if the premium rates to be charged for cr…

(a) The premium rate standards set forth below are applicable to plans of credit life insurance with or without requirements for evidence of insurability: (1) Which contain no exclusions or no exclusions other than suicide; and (2) Which contain no age restrictions, or only age r…

(a) The rate standards set forth below shall be applicable for contracts which contain a provision excluding or denying claim for disability resulting from preexisting illness, disease or physical condition, for which the debtor received medical advice, consultation, or treatment…

As used in this Article, unless the context requires otherwise, the following words or terms shall have the meanings herein ascribed to them, respectively: (1) Repealed by Session Laws 1991, c. 720, s. 6. (2) "Credit accident and health insurance" means insurance on a debtor to p…

(a) Each individual policy or group certificate shall provide that in the event of termination of the insurance prior to the scheduled maturity date of indebtedness, any refund of an amount paid by the debtor for insurance shall be paid or credited promptly to the person entitled…

All policies of credit life insurance and credit accident and health insurance shall be issued only by an insurer authorized to do business in this State and shall be issued only through holders of licenses or authorizations issued by the Commissioner. With the exception of credi…

(a) All claims shall be promptly reported to the insurer or its designated claim representative, and the insurer shall maintain adequate claim files. All claims shall be settled as soon as possible and in accordance with the terms of the insurance contract. (b) All claims shall b…

Credit life insurance and credit accident and health insurance may not be required of any borrower by any creditor. When credit property insurance is required for any indebtedness, the debtor shall be notified in writing of the option of furnishing the required amount of insuranc…

(a) The Commissioner may, after notice and opportunity for a hearing, impose civil penalties or petition for restitution under G.S. 58-2-70, revoke, suspend, or restrict the license of any insurer if: (1) The insurer fails or refuses to comply with any law, order, or rule applica…

Any party to the proceeding affected by an order of the Commissioner shall be entitled to judicial review by following the procedure set forth in G.S. 58-2-75 through 58-2-90. (1975, c. 660, s. 1.)

(a) As used in this Article, the term "single interest credit property" insurance means insurance of the personal property of the debtor against loss, with the creditor as sole beneficiary; and the term "dual credit property" insurance means insurance of personal property of the …

It shall be unlawful for any insurance carrier, or officer, agent or representative of an insurance company writing credit life and credit accident and health insurance, as defined in G.S. 58-58-10 and G.S. 58-51-100, or combination credit life, accident and health, hospitalizati…

(a) All corporations or associations doing business in this State, under any charter or statute of this or any other state, involving the payment of money or other thing of value to families or representatives of policy and certificate holders or members, conditioned upon the con…

Credit life insurance is declared to be insurance upon the life of a debtor who may be indebted to any person, firm, or corporation extending credit to said debtor. Credit life insurance may include the granting of additional benefits in the event of total and permanent disabilit…

All minors in North Carolina of the age of 15 years and upwards shall have full power and authority to make contracts of insurance or annuity with any life insurance company authorized to do business in the State of North Carolina, either domestic or foreign, and to exercise all …

A beneficiary of a life insurance policy who did not possess the incidents of ownership under the policy at the time of death of the insured may renounce as provided in Chapter 31B of the General Statutes. (1975, c. 371, s. 5.)

(a) Each insurer admitted to transact insurance in this State which, without the written consent of the beneficiary, fails or refuses to pay the death proceeds or death benefits in accordance with the terms of any policy providing a death benefit issued by it in this State within…

If a policy of insurance is effected by any person on his own life or on another life in favor of a person other than himself, or, except in cases of transfer with intent to defraud creditors, if a policy of life insurance is assigned or in any way made payable to any such person…

No life insurance corporation doing business in this State shall, within one year after the default in payment of any premium, installment, or interest, declare forfeited or lapsed any policy hereafter issued or renewed, except policies on which premiums are payable monthly or at…