HB 163 North Carolina House · 2025-2026 Session

Pharmacy Benefits Manager Provisions.

HB 163 regulates Pharmacy Benefits Managers (PBMs) to ensure fair practices for pharmacies and insured individuals. The bill prohibits PBMs from charging insurers more for a prescription drug than they pay the pharmacy (spread pricing) and requires patient out-of-pocket costs to be based on the net price after any PBM concessions. It establishes minimum reimbursement standards for pharmacies, preventing PBMs from paying less than the national average drug acquisition cost plus a dispensing fee. Additionally, it clarifies that PBMs cannot restrict accredited pharmacies from dispensing specialty drugs and strengthens audit protections for pharmacies.
Bill status passed 3 of 5 stages cleared
Introduction
Feb 2025
Committee Review
Apr 2025
House Passage
Apr 2025
Senate Passage
Governor
Introduced Feb 21, 2025 Last action Apr 30, 2025
Maddy AI version diff · 3 comparisons

What changed between versions

Edition 2 Edition 3 · 3 edits
MINOR
The bill was updated from Edition 2 to Edition 3, adding a second committee substitute version dated April 15, 2025. The most significant substantive change is the redefinition of 'specialty pharmacy' to explicitly require accreditation by a nationally recognized organization, replacing the previous definition that focused on 'specialty pharmacy accreditation' as a separate term. Additionally, the definition of 'generic equivalent' was reorganized to list quality standards before therapeutic effects.
Scope change
The bill's scope regarding specialty pharmacy management was narrowed by adding a mandatory accreditation requirement to the definition of a specialty pharmacy.
DEFINITION

The definition of 'specialty pharmacy' was changed to require that the pharmacy be accredited by a nationally recognized, independent accrediting organization, whereas the previous version defined 'specialty pharmacy accreditation' as a separate certification term.

The definition of 'generic equivalent' was restructured to list quality and purity standards (USP or other compendium) before the requirement for comparable therapeutic effects, reversing the order found in the previous version.

TECHNICAL

A new page header indicating 'Committee Substitute #2 Favorable 4/15/25' was added, reflecting the bill's progression through the legislative committee.

Floor votes · House Apr 29, 2025

How they voted

1079
Passed · 5 other
Total votes 121
Apr 29, 2025
D Democratic46
34 Yea 9 Nay 3
73% Yea
I Independent2
2 Yea
100% Yea
R Republican73
71 Yea 2
97% Yea
Vote distribution
All Yea All Nay Mixed No data
Full legislative history

Actions timeline

Total actions
16
Key actions
4
Committee
7
Apr 30, 2025
Committee
Ref To Com On Rules and Operations of the Senate
upper
Apr 29, 2025
Lower · Passed
Passed 3rd Reading
lower
Apr 15, 2025
Lower · Passed
Reptd Fav
lower
Apr 15, 2025
Committee
Re-ref Com On Rules, Calendar, and Operations of the House
lower
Apr 15, 2025
Lower · Passed
Reptd Fav Com Sub 2
lower
Apr 1, 2025
Committee
Re-ref Com On Regulatory Reform
lower
Apr 1, 2025
Lower · Passed
Reptd Fav Com Substitute
lower
Feb 24, 2025
Committee
Ref to the Com on Health, if favorable, Regulatory Reform, if favorable, Rules, Calendar, and Operations of the House
lower
Feb 21, 2025
Introduced
Filed
lower
3 primary · 32 co-sponsors

Sponsors