North Carolina 2023-2024 Session Status: In Committee Bipartisan · 9 D · 4 R · 1 I cosponsors

HB 680 — Improved Access to Severe Mental Illness Prescription Drugs.

Last action — Passed 1st Reading

  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed House
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2023-2024 Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there are no live odds of enactment. It would have to be reintroduced in the current session to move again.

Bill Text

What changed in the latest version

106 added · 98 removed

Plain-language change summary

The amendment to House Bill 680 includes two significant changes. First, it reinforces the requirement for insurers and pharmacy benefits managers to adhere to conflict of interest standards set by reputable organizations, which helps ensure unbiased decision-making about medications. Second, it clarifies that enrollees can obtain coverage for specific nonformulary drugs if deemed medically necessary by their prescribing provider, without facing extra costs beyond their usual plan's terms. This matters because it improves access to necessary medications and supports patients in getting the treatment they need.

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GENERAL ASSEMBLY OF NORTH CAROLINA H.B.
GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2023 H 1 HOUSE BILL 680 Short Title:
680 Apr 18, 2023 SESSION 2023 HOUSE PRINCIPAL CLERK H D HOUSE BILL DRH40371-MR-83A Short Title:
Representative K.
Representatives K.
Baker.
Baker, Sasser, Reeder, and White (Primary Sponsors).
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
A BILL TO BE ENTITLED AN ACT TO IMPROVE ACCESS TO PRESCRIPTION MEDICATIONS USED IN THE TREATMENT AND PREVENTION OF SEVERE MENTAL ILLNESS IN ORDER TO ACHIEVE BETTER OUTCOMES FOR PATIENTS WITH SEVERE MENTAL ILLNESS IN NORTH CAROLINA.
Health, if favorable, Insurance, if favorable, Rules, Calendar, and Operations of the House April 19, 2023 A BILL TO BE ENTITLED AN ACT TO IMPROVE ACCESS TO PRESCRIPTION MEDICATIONS USED IN THE TREATMENT AND PREVENTION OF SEVERE MENTAL ILLNESS IN ORDER TO ACHIEVE BETTER OUTCOMES FOR PATIENTS WITH SEVERE MENTAL ILLNESS IN NORTH CAROLINA.
… (4) An insurer, or a pharmacy benefits manager under contract with an insurer, shallrequireRequirethatitspharmacyandtherapeuticscommitteeeithermeet *DRH40371-MR-83A* General Assembly Of North Carolina Session 2023 the requirements for conflict of interest set by the Center for Medicare and Medicaid Services or meet the accreditation standards of the National Committee for Quality Assurance or another independent accrediting organization.
… *H680-v-1* General Assembly Of North Carolina Session 2023 (4) An insurer, or a pharmacy benefits manager under contract with an insurer, shallrequireRequirethatitspharmacyandtherapeuticscommitteeeithermeet the requirements for conflict of interest set by the Center for Medicare and Medicaid Services or meet the accreditation standards of the National Committee for Quality Assurance or another independent accrediting organization.
– Each insurer shall establish and maintain an expeditious process or procedure, published on either the insurer's Web site website or in policies provided to health care providers, that allows an enrollee enrollee, or the enrollee's prescribing provider acting on behalf of the enrollee enrollee, to obtain, without penalty or additional cost-sharing beyond that provided for in the health benefit plan, either coverage for a specific nonformulary drug or device or the drug requested by the prescribing provider, if it is determined to be medically necessary and appropriate by the enrollee's prescribing provider and the prescription drug is covered under the current health benefit plan.
– Each insurer shall establish and maintain an expeditious process or procedure, published on either the insurer's Web site website or in policies provided to health care providers, that allows an enrollee enrollee, or the enrollee's prescribing provider acting on behalf of the enrollee enrollee, to obtain, without penalty or additional cost-sharing beyond that provided for in the health benefit plan, either coverage for a specific nonformularydrugor device or the drug requested by the prescribing provider, if it is determined to be medically necessary and appropriate by the enrollee's prescribing provider and the prescription drug is covered under the current health benefit plan.
(3) "Restricted access drug or device" means those covered prescription drugs or devices for which reimbursement by the insurer is conditioned on the insurer's prior approval to prescribe the drug or device or on the provider prescribing one or more alternative drugs or devices before prescribing the drug or device in question.
(3) "Restricted access drug or device" means those covered prescription drugs or devices for which reimbursement bythe insurer is conditioned on the insurer's prior approval to prescribe the drug or device or on the provider prescribing one or more alternative drugs or devices before prescribing the drug or device in question.
… (e) This With the exception of the restrictions imposed under subsection (b4) of this section, this section shall not be construed to prevent the health benefit plan from requiring an Page 2 DRH40371-MR-83A General Assembly Of North Carolina Session 2023 enrollee to try an A-rated generic equivalent drug, or a biosimilar, as defined under 42 U.S.C.
… Page 2 House Bill 680-First Edition General Assembly Of North Carolina Session 2023 (e) This With the exception of the restrictions imposed under subsection (b4) of this section, this section shall not be construed to prevent the health benefit plan from requiring an enrollee to try an A-rated generic equivalent drug, or a biosimilar, as defined under 42 U.S.C.
(b) No Medicaid beneficiary may be required to try a different prescription medication used to treat schizophrenia prior to the approval of coverage for any antipsychotic injectable drug prescribed for the treatment of schizophrenia.
(b) No Medicaid beneficiary may be required to try a different prescription medication used to treat schizophrenia prior to the approval of coverage for anyantipsychotic injectable drug prescribed for the treatment of schizophrenia.
(c) A Medicaid beneficiary may not be required to try a different prescription medication used to treat severe mental illness prior to the approval of coverage for a medication prescribed to the beneficiary for that severe mental illness, a practice known as step therapy, if all of the following conditions are met:
(c) A Medicaid beneficiary maynot be required to try a different prescription medication used to treat severe mental illness prior to the approval of coverage for a medication prescribed to the beneficiary for that severe mental illness, a practice known as step therapy, if all of the following conditions are met:
The beneficiary was prescribed and unsuccessfully treated with a prescription medication that is designated as a preferred drug under any Medicaid prescriptiondrugformulary, whetherthatpreferreddrug is a brand or generic drug.
The beneficiary was prescribed and unsuccessfully treated with a prescription medication that is designated as a preferred drug under anyMedicaid prescriptiondrugformulary, whetherthatpreferreddrug is a brand or generic drug.
DRH40371-MR-83A Page 3
House Bill 680-First Edition Page 3
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Action History

  1. Passed 1st Reading

  2. Ref to the Com on Health, if favorable, Insurance, if favorable, Rules, Calendar, and Operations of the House

  3. Filed

Sponsors

Sponsorship breakdown

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3 sponsors · 18 co-sponsors · 158 not signed on

Sponsors (3)

Co-sponsors (18)

Not signed on (158)

158 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

public-safety healthcare health-insurance
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Frequently asked questions

Who sponsors HB 680?
HB 680 is sponsored by Joe John (Democratic), Sasser, Reeder, Donna McDowell White (Republican), Autry, Mary Belk (Democratic), Laura Budd (Democratic), Tricia Ann Cotham (Republican), Crutchfield, Carla D. Cunningham (U), Faircloth, Fontenot, Pricey Harrison (Democratic), Ya Liu (Democratic), Jeffrey C. McNeely (Republican), Marcia Morey (Democratic), Lindsey Prather (Democratic), Bill Ward (Republican), Shelly Willingham (Democratic), Wray, and Amber M. Baker (Democratic).
What is the current status of HB 680?
This bill died with 2023-2024 Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track HB 680?
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