North Carolina SB 976: Reduce Healthcare Costs and Protect Patients.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 1
SENATE BILL 976

Short Title: Reduce Healthcare Costs & Protect Patients. (Public)
Sponsors: Senator Grafstein (Primary Sponsor).
Referred to: Rules and Operations of the Senate
May 4, 2026
*S976-v-1*
A BILL TO BE ENTITLED 1
AN ACT REDUCING HEALTHCARE COSTS AND PROTECTING PATIENTS. 2
Whereas, rising healthcare costs place a significant financial burden on individuals, 3
families, employers, and taxpayers; greatly contribute to inflation; and make it increasingly 4
difficult for residents to access essential healthcare services; and 5
Whereas, North Carolina has intolerably high healthcare costs, with recent studies 6
ranking the State 50th out of 50 in the United States; and 7
Whereas, skyrocketing healthcare costs have resulted in over forty percent (40%) of 8
Americans reporting some type of healthcare debt, according to one study; and 9
Whereas, many patients face unexpected medical bills due to a lack of disclosure 10
about out-of-network providers and a general lack of transparency in healthcare pricing, resulting 11
in financial strain and hardship; and 12
Whereas, patients and employers are often unable to compare the costs of medical 13
services due to a lack of clear and accessible pricing information, hindering their ability to make 14
informed decisions; Now, therefore, 15
The General Assembly of North Carolina enacts: 16
17
PART I. PRESCRIPTION DRUG AFFORDABILITY 18
SECTION 1.1.(a) Article 3 of Chapter 58 of the General Statutes is amended by 19
adding a new section to read: 20
"§ 58-3-182. Limits on cost-sharing. 21
Prescription Drugs. – The cost-sharing for any health benefit plan for the coverage of 22
prescription drugs shall not exceed the annual amount of two thousand dollars ($2,000) per 23
covered person. Cost-sharing includes copayments, deductibles, and any other out-of-pocket 24
expense for a prescription drug paid by the covered individual." 25
SECTION 1.1.(b) This section is effective October 1, 2026, and applies to insurance 26
contracts entered into, renewed, or amended on or after that date. 27
28
PART II. SURPRISE BILLING AND EMERGENCY PROTECTION 29
SECTION 2.1.(a) G.S. 58-3-182, as enacted by Section 1.1(a) of this act, reads as 30
rewritten: 31
"§ 58-3-182. Limits on cost-sharing. 32
(a) Prescription Drugs. – The cost-sharing for any health benefit plan for the coverage of 33
prescription drugs shall not exceed the annual amount of two thousand dollars ($2,000) per 34
covered person. Cost-sharing includes copayments, deductibles, and any other out-of-pocket 35
expense for a prescription drug paid by the covered individual. 36

General Assembly Of North Carolina Session 2025
Page 2 Senate Bill 976-First Edition
(b) In-Network Facilities. – All nonemergency care provided at a facility that is part of 1
the health benefit plan's provider network shall be charged to the covered individual at an 2
in-network rate. No health benefit plan shall allow for any cost-sharing at an out-of-network rate 3
so long as the facility in which the care is provided is in the health benefit plan's provider 4
network." 5
SECTION 2.1.(b) G.S. 58-3-200(d) reads as rewritten: 6
"(d) Services Outside Provider Networks. – No insurer shall penalize an insured or subject 7
an insured to the out-of-network benefit levels offered under the insured's approved health benefit 8
plan, including an insured receiving an extended or standing referral under G.S. 58-3-223, unless 9
contracting health care healthcare providers able to meet health needs of the insured are 10
reasonably available to the insured without unreasonable delay. Upon notice or request from the 11
insured, the insurer shall determine whether a healthcare provider able to meet the needs of the 12
insured is available to the insured without unreasonable delay by reference to the insured's 13
location and the specific medical needs of the insured." 14
SECTION 2.1.(c) This section becomes effective October 1, 2026, and applies to 15
healthcare services provided on or after that date and to contracts issued, renewed, or amended 16
on or after that date. 17
SECTION 2.2. Beginning with the 2027 calendar year, emergency ground 18
ambulance services shall be considered part of the essential health benefit package under 45 19
C.F.R. § 147.150(a). The Commissioner of the Department of Insurance shall communicate this 20
change to the federal Centers for Medicare and Medicaid Services and to all insurers offering a 21
health benefit plan in North Carolina on the federally facilitated marketplace. 22
23
PART III. MEDICAL DEBT PREVENTION 24
SECTION 3.1.(a) Chapter 131E of the General Statutes is amended by adding a new 25
Article 11C to be entitled "Fair Billing and Collections Practices for Hospitals and Ambulatory 26
Surgical Facilities." 27
SECTION 3.1.(b) G.S. 131E-91 is recodified as G.S. 131E-214.50 under Article 28
11C of Chapter 131E of the General Statutes, as created by subsection (a) of this sect