North Carolina HB 824: Expand Treatment Access/Opioid Use Disorder.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 824

Short Title: Expand Treatment Access/Opioid Use Disorder. (Public)
Sponsors: Representatives White and Huneycutt (Primary Sponsors).
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
Referred to: Insurance, if favorable, Finance, if favorable, Rules, Calendar, and Operations of
the House
April 9, 2025
*H824-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO EXPAND ACCESS TO TREATMENT FOR OPIOID OVERDOSE AND OPIOID 2
USE DISORDER BY UPDATING HEALTH BENEFIT PLAN COVERAGE OF, AND 3
REIMBURSEMENT FOR, OVERDOSE AND SUBSTANCE USE DISORDER 4
MEDICATIONS AND TO MAKE TECHNICAL AND CONFORMING CHANGES TO 5
UPDATE THE GENERAL STATUTES THAT RELATE TO MENTAL HEALTH 6
COVERAGE UNDER HEALTH BENEFIT PLANS. 7
The General Assembly of North Carolina enacts: 8
9
PART I. CREATE PARITY FOR COVERAGE UNDER A HEALTH BENEFIT PLAN 10
APPLICABLE TO PHARMACIES AND PHARMACISTS 11
12
REQUIRE CERTAIN PHARMACY SERVICES TO BE COVERED UNDER A HEALTH 13
BENEFIT PLAN 14
SECTION 1.1.(a) Article 3 of Chapter 58 of the General Statutes is amended by 15
adding a new section to read: 16
"§ 58-3-241. Healthcare services provided by pharmacists. 17
(a) The following definitions apply in this section: 18
(1) Healthcare services. – Any of the following health or medical procedures or 19
services rendered by a healthcare provider: 20
a. Testing, assessment, and management of a health condition, illness, 21
injury, or disease. This includes testing, diagnosis, or treatment 22
rendered by a pharmacist acting within the pharmacist's scope of 23
practice. 24
b. Dispensing of drugs, medical devices, medical appliances, or medical 25
goods for the treatment of a health condition, illness, injury, or disease. 26
c. Administration of a vaccine or medication, including long-term 27
injectables such as buprenorphine. 28
(2) Pharmacist. – An individual licensed to practice pharmacy under Article 4A 29
of Chapter 90 of the General Statutes or the relevant laws of another state. 30
(b) A health benefit plan offered by an insurer in this State shall cover healthcare services 31
provided by a pharmacist if all of the following conditions are met: 32
(1) The service or procedure was performed within the pharmacist's licensed 33
lawful scope of practice. 34

General Assembly Of North Carolina Session 2025
Page 2 House Bill 824-First Edition
(2) The health benefit plan would have covered the service if the service or 1
procedure had been performed by another healthcare provider. 2
(c) The participation of a pharmacy in a drug benefit provider network of a health benefit 3
plan shall not satisfy any requirement that insurers offering health benefit plans include 4
pharmacists in medical benefit provider networks." 5
SECTION 1.1.(b) This section is effective October 1, 2025, and applies to insurance 6
contracts issued, amended, or renewed on or after that date. 7
8
ACCEPT HEALTHCARE FACILITY CREDENTIALING FOR PHARMACISTS 9
EMPLOYED BY THE FACILITY 10
SECTION 1.2.(a) G.S. 58-3-230 is amended by adding a new subsection to read: 11
"(d) Insurers that delegate credentialing agreements or requirements for pharmacists 12
licensed under Article 4A of Chapter 90 of the General Statutes or the relevant laws of another 13
state to a contracted healthcare facility shall accept the credentialing for all pharmacists employed 14
by, or contracted with, those healthcare facilities." 15
SECTION 1.2.(b) This section is effective October 1, 2025, and applies to insurance 16
contracts issued, amended, or renewed on or after that date. 17
18
PART II. ENHANCE COVERAGE OF PRESCRIPTION DRUGS FOR OPIOID 19
DISORDER AND OPIOID OVERDOSE UNDER HEALTH BENEFIT PLANS 20
SECTION 2.1. G.S. 58-3-220 is amended by adding a new subsection to read: 21
"(k) Select Prescription Drugs. – Insurers offering a health benefit plan shall provide 22
coverage of all prescription drugs approved by the United States Food and Drug Administration 23
for the treatment of opioid disorder and opioid overdose. If an insurer maintains one or more 24
closed formularies, then all prescription drugs requiring coverage under this section shall be 25
included on those formularies. The following shall apply to prescription drugs for which coverage 26
is required under this subsection: 27
(1) The prescription drug shall not be subject to prior authorization as a condition 28
of coverage. 29
(2) Pharmacies dispensing the prescription drug shall be reimbursed at the most 30
recent National Average Drug Acquisition Cost price plus a dispensing fee. If 31
the prescription drug dispensed is not available on the most recent National 32
Average Drug Acquisition Cost price list, then the most recent Wholesale 33
Acquisition Cost price plus a dispensing fee shall be used to reimburse 34
pharmacies for dispensing the prescription drug." 35
SECTION 2.2. This Part is effective October 1, 2025, and applies to insurance 36
contracts issued, amended, or ren