NORTH CAROLINA SUMMARY OF EXISTING LAW

A PBM may only charge a fee 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 PBM and the pharmacy.

Link to Existing Law: NC ST § 58-56A-4

PRACTICAL NOTE

Limits what PBMs can charge via their own contracts. Allows more transparency by requiring that the PBMs set the DIR fee via the contract or report the fee on remittance. This was done to eliminate the element of surprise that happens often with DIR fees. Given that it is somewhat vague, it may not provide the same level of protection against DIR fees as with other state laws.