SB 414 — Pharmacists/Test and Treat.

Bill Text

Compared against the N.C. General Statutes as published AI-generated reading aid — verify against the official bill.

The bill expands the definitions and responsibilities of pharmacists to include testing and treating certain illnesses, allows for their reimbursement for such services, and includes provisions for insurance coverage.

• N.C.G.S. § 90-85.3

  "CLIA-waived test" means a laboratory test approved by the Food and Drug Administration and determined by the Centers for Medicare and Medicaid Services to qualify for a waiver under the federal Clinical Laboratory Improvement Amendments of 1988 and safe for use in non-laboratory settings.

  Updates the definition of 'CLIA-waived test' to include approval by the Centers for Medicare and Medicaid Services.

• N.C.G.S. § 90-85.3

  "Clinical pharmacist practitioner" means a licensed pharmacist who meets the guidelines and criteria for such title established by the joint subcommittee of the North Carolina Medical Board and the North Carolina Board of Pharmacy and is authorized to enter into drug therapy management agreements with physicians in accordance with the provisions of G.S. 90-18.4.

  Clarifies the definition of 'Clinical pharmacist practitioner' to include authority for drug therapy management agreements.

• N.C.G.S. § 90-85.3A

  A pharmacist may order and perform a CLIA-waived test to do any of the following: (1) Assist with clinical decision making related to the use and monitoring of medications. (2) Treat influenza, COVID-19, pharyngitis caused by group A streptococcus, and other health conditions screened by utilizing a CLIA-waived test, in accordance with statewide protocols.

  Allows pharmacists to order and perform CLIA-waived tests for specific health conditions.

• N.C.G.S. § 58-3-241

  (a) The following definitions apply in this section: (1) Healthcare provider. – Either of the following: a. An individual who is licensed, certified, or otherwise authorized under Chapter 90 of the General Statutes to provide healthcare services in the ordinary course of business or practice of a profession or in an approved education or training program. b. A health care facility licensed under Chapter 131E or Chapter 122C of the General Statutes and where healthcare services are provided to patients.

  Defines 'healthcare provider' for the purposes of the new section regarding services provided by pharmacists.

• N.C.G.S. § 58-3-241

  (2) Healthcare services. – Any of the following health or medical procedures or services rendered by a healthcare provider: a. Testing, diagnosis, or treatment of a health condition, illness, injury, or disease. This includes testing, diagnosis, or treatment rendered by a pharmacist acting within the pharmacist's scope of practice.

  Defines 'healthcare services' to explicitly include services provided by pharmacists.

• N.C.G.S. § 58-3-241

  A health benefit plan offered by an insurer in this State shall cover healthcare services provided by a pharmacist if all of the following conditions are met: (1) The service or procedure was performed within the pharmacist's licensed lawful scope of practice. (2) The health benefit plan would have covered the service if the service or procedure had been performed by another healthcare provider.

  Requires health benefit plans to cover services provided by pharmacists under certain conditions.

• N.C.G.S. § 58-3-230

  (d) Insurers that delegate credentialing agreements or requirements for pharmacists licensed under Article 4A of Chapter 90 of the General Statutes or the relevant laws of another state to a contracted healthcare facility shall accept the credentialing for all pharmacists employed by, or contracted with, those healthcare facilities.

  Mandates that insurers accept the credentialing of pharmacists for services provided at contracted healthcare facilities.

• N.C.G.S. § 58-3-200(d)

  No insurer shall penalize an insured or subject an insured to the out-of-network benefit levels offered under the insured's approved health benefit plan, including an insured receiving an extended or standing referral under G.S. 58-3-223, unless contracting healthcare providers able to meet health needs of the insured are reasonably available to the insured without unreasonable delay.

  Protects insured patients from penalties when seeking services outside of provider networks, provided there are no reasonable alternatives.

• N.C.G.S. § 58-56-26

  (e) Notwithstanding any provision of this Article to the contrary, all requirements relating to the coverage of prescription drugs and pharmacy services under this Chapter that apply to health benefit plans are applicable to a third-party administrator in the same way they are applicable to an insurer.

  Ensures that third-party administrators are subject to the same coverage requirements for prescription drugs and pharmacy services as insurers.

• N.C.G.S. § 58-56A-55

  All requirements relating to the coverage of prescription drugs and pharmacy services under this Chapter that apply to health benefit plans are applicable to a pharmacy benefits manager in the same way they are applicable to an insurer.

  Extends the same coverage requirements for prescription drugs and pharmacy services to pharmacy benefits managers.

Action History

1. March 25, 2025

   Passed 1st Reading

2. March 25, 2025

   Ref To Com On Rules and Operations of the Senate

3. March 24, 2025

   Filed

Sponsors

• Ralph Hise · Cosponsor
• Bobby Hanig · Cosponsor
• Jim Burgin · Cosponsor
• Gale Adcock · Cosponsor
• Timothy D. Moffitt · Cosponsor
• Carl Ford · Primary
• Dana Jones · Primary

Subjects