North Carolina 2025-2026 Regular Session

North Carolina House Bill H824 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		GENERAL ASSEMBLY OF NORTH CAROLINA
2	2		SESSION 2025
3		-	H 1
4		-	HOUSE BILL 824
	3	+	H D
	4	+	HOUSE BILL DRH30343-MR-58A
	5	+
5	6
6	7
7	8		Short Title: Expand Treatment Access/Opioid Use Disorder. (Public)
8		-	Sponsors: Representatives White and Huneycutt (Primary Sponsors).
9		-	For a complete list of sponsors, refer to the North Carolina General Assembly web site.
10		-	Referred to: Insurance, if favorable, Finance, if favorable, Rules, Calendar, and Operations of
11		-	the House
12		-	April 9, 2025
13		-	H824 -v-1
	9	+	Sponsors: Representative White.
	10	+	Referred to:
	11	+
	12	+	DRH30343 -MR-58A
14	13		A BILL TO BE ENTITLED 1
15	14		AN ACT TO EXPAND ACCESS TO TREATMENT FOR OPIOID OVERDOSE AND OPIOID 2
16	15		USE DISORDER BY UPDATING HEALTH BENEFIT PLAN COVERAGE OF, AND 3
17	16		REIMBURSEMENT FOR, OVERDOSE AND SUBSTANCE USE DISORDER 4
18	17		MEDICATIONS AND TO MAKE TECHNICAL AND CONFORMING CHANGES TO 5
19	18		UPDATE THE GENERAL STATUTES THAT RELATE TO MENTAL HEALTH 6
20	19		COVERAGE UNDER HEALTH BENEFIT PLANS . 7
21	20		The General Assembly of North Carolina enacts: 8
22	21		9
23	22		PART I. CREATE PARITY FOR COVERAGE UNDER A HEALTH BENEFIT PLAN 10
24	23		APPLICABLE TO PHARMACIES AND PHARMACISTS 11
25	24		12
26	25		REQUIRE CERTAIN PHARMACY SERVICES TO BE COVERED UNDER A HEALTH 13
27	26		BENEFIT PLAN 14
28	27		SECTION 1.1.(a) Article 3 of Chapter 58 of the General Statutes is amended by 15
29	28		adding a new section to read: 16
30	29		"§ 58-3-241. Healthcare services provided by pharmacists. 17
31	30		(a) The following definitions apply in this section: 18
32	31		(1) Healthcare services. – Any of the following health or medical procedures or 19
33	32		services rendered by a healthcare provider: 20
34	33		a. Testing, assessment, and management of a health condition, illness, 21
35	34		injury, or disease. This includes testing, diagnosis, or treatment 22
36	35		rendered by a pharmacist acting within the pharmacist's scope of 23
37	36		practice. 24
38	37		b. Dispensing of drugs, medical devices, medical appliances, or medical 25
39	38		goods for the treatment of a health condition, illness, injury, or disease. 26
40	39		c. Administration of a vaccine or medication, including long-term 27
41	40		injectables such as buprenorphine. 28
42	41		(2) Pharmacist. – An individual licensed to practice pharmacy under Article 4A 29
43	42		of Chapter 90 of the General Statutes or the relevant laws of another state. 30
44	43		(b) A health benefit plan offered by an insurer in this State shall cover healthcare services 31
45	44		provided by a pharmacist if all of the following conditions are met: 32
46	45		(1) The service or procedure was performed within the pharmacist's licensed 33
47		-	lawful scope of practice. 34 General Assembly Of North Carolina Session 2025
48		-	Page 2 House Bill 824-First Edition
49		-	(2) The health benefit plan would have covered the service if the service or 1
50		-	procedure had been performed by another healthcare provider. 2
51		-	(c) The participation of a pharmacy in a drug benefit provider network of a health benefit 3
52		-	plan shall not satisfy any requirement that insurers offering health benefit plans include 4
53		-	pharmacists in medical benefit provider networks." 5
54		-	SECTION 1.1.(b) This section is effective October 1, 2025, and applies to insurance 6
55		-	contracts issued, amended, or renewed on or after that date. 7
56		-	8
57		-	ACCEPT HEALTHCARE FACILITY CREDENTIALING FOR PHARMACISTS 9
58		-	EMPLOYED BY THE FACILITY 10
59		-	SECTION 1.2.(a) G.S. 58-3-230 is amended by adding a new subsection to read: 11
60		-	"(d) Insurers that delegate credentialing agreements or requirements for pharmacists 12
61		-	licensed under Article 4A of Chapter 90 of the General Statutes or the relevant laws of another 13
62		-	state to a contracted healthcare facility shall accept the credentialing for all pharmacists employed 14
63		-	by, or contracted with, those healthcare facilities." 15
64		-	SECTION 1.2.(b) This section is effective October 1, 2025, and applies to insurance 16
65		-	contracts issued, amended, or renewed on or after that date. 17
66		-	18
67		-	PART II. ENHANCE COV ERAGE OF PRESCRIPTION DRUGS F OR OPIOID 19
68		-	DISORDER AND OPIOID OVERDOSE UNDER HEALT H BENEFIT PLANS 20
69		-	SECTION 2.1. G.S. 58-3-220 is amended by adding a new subsection to read: 21
70		-	"(k) Select Prescription Drugs. – Insurers offering a health benefit plan shall provide 22
71		-	coverage of all prescription drugs approved by the United States Food and Drug Administration 23
72		-	for the treatment of opioid disorder and opioid overdose. If an insurer maintains one or more 24
73		-	closed formularies, then all prescription drugs requiring coverage under this section shall be 25
74		-	included on those formularies. The following shall apply to prescription drugs for which coverage 26
75		-	is required under this subsection: 27
76		-	(1) The prescription drug shall not be subject to prior authorization as a condition 28
77		-	of coverage. 29
78		-	(2) Pharmacies dispensing the prescription drug shall be reimbursed at the most 30
79		-	recent National Average Drug Acquisition Cost price plus a dispensing fee. If 31
80		-	the prescription drug dispensed is not available on the most recent National 32
81		-	Average Drug Acquisition Cost price list, then the most recent Wholesale 33
82		-	Acquisition Cost price plus a dispensing fee shall be used to reimburse 34
83		-	pharmacies for dispensing the prescription drug." 35
84		-	SECTION 2.2. This Part is effective October 1, 2025, and applies to insurance 36
85		-	contracts issued, amended, or renewed on or after that date. 37
86		-	38
87		-	PART III. CONFORM TO FEDERAL LAW AND MAK E OTHER TECHNICAL 39
88		-	CHANGES TO UPDATE TH E GENERAL STATUTES T HAT RELATE TO MENTAL 40
89		-	HEALTH COVERAGE UNDE R HEALTH BENEFIT PLA NS 41
90		-	SECTION 3.1.(a) Subsections (b), (c), (d), and (j) of G.S. 58-3-220 are repealed. 42
91		-	SECTION 3.1.(b) Subsection (h) of G.S. 58-3-220 is recodified as subsection (a1) 43
92		-	of G.S. 58-3-220. 44
93		-	SECTION 3.2. G.S. 58-3-220, as amended by Part II and Section 3.1 of this act, 45
94		-	reads as rewritten: 46
95		-	"§ 58-3-220. Mental illness health benefits coverage. 47
96		-	(a) Mental Health Equity Requirement. – Except as provided in subsection (b), an insurer 48
97		-	shall provide in each group health benefit plan benefits for All health benefit plans shall provide 49
98		-	coverage for the necessary care and treatment of mental illnesses health conditions that are no 50
99		-	less favorable than benefits for the necessary care and treatment of physical illness generally, 51 General Assembly Of North Carolina Session 2025
100		-	House Bill 824-First Edition Page 3
101		-	including application of the same limits. For purposes of this subsection, mental illnesses are as 1
102		-	diagnosed and defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, or 2
103		-	a subsequent edition published by the American Psychiatric Association, except those mental 3
104		-	disorders coded in the DSM-5 or subsequent edition as autism spectrum disorder (299.00), 4
105		-	substance-related disorders (291.0 through 292.2 and 303.0 through 305.9), those coded as sexual 5
106		-	dysfunctions not due to organic disease (302.70 through 302.79), and those coded as "V" codes. 6
107		-	For purposes of this subsection, "limits" includes deductibles, coinsurance factors, co-payments, 7
108		-	maximum out-of-pocket limits, annual and lifetime dollar limits, and any other dollar limits or 8
109		-	fees for covered services.health conditions. 9
110		-	(a1) Definitions. – As used The following definitions apply in this section: 10
111		-	(1) "Health benefit plan" has the same meaning as Health benefit plan. – As 11
112		-	defined in G.S. 58-3-167. 12
113		-	(2) "Insurer" has the same meaning as Insurer. – As defined in G.S. 58-3-167. 13
114		-	(3) Medical necessity. – As defined in G.S. 58-50-61. 14
115		-	(4) "Mental illness" has the same meaning as in G.S. 122C-3(21), with a Mental 15
116		-	health condition. – A mental disorder defined in the Diagnostic and Statistical 16
117		-	Manual of Mental Disorders, DSM-5, or subsequent editions published by the 17
118		-	American Psychiatric Association, except this term does not include those 18
119		-	mental disorders coded in the DSM-5 or subsequent editions as autism 19
120		-	spectrum disorder (299.00), substance-related disorders (291.0 through 292.9 20
121		-	and 303.0 through 305.9), those coded as sexual dysfunctions not due to 21
122		-	organic disease (302.70 through 302.79), and those coded as "V" codes. 22
123		-	… 23
124		-	(g) Utilization Review. – Nothing in this section prevents an insurer from applying 24
125		-	utilization review criteria to determine medical necessity as defined in G.S. 58-50-61 as long as 25
126		-	it does so in accordance with all requirements for utilization review programs and medical 26
127		-	necessity determinations specified in that section, including the offering of an insurer appeal 27
128		-	process and, where applicable, health benefit plan external review as provided for in Part 4 of 28
129		-	Article 50 of Chapter 58 of the General Statutes.in accordance with G.S. 58-50-61. 29
130		-	… 30
131		-	(i) Notwithstanding any other provisions of this section, a group health benefit plan that 31
132		-	covers both medical and surgical benefits and mental health benefits shall, with respect to the 32
133		-	mental health benefits, comply with all Federal Law Applies. – All applicable standards of 33
134		-	Subtitle B of Title V of Public Law 110-343, known as the Paul Wellstone and Pete Domenici 34
135		-	Mental Health Parity and Addiction Equity Act of 2008, and the applicable regulations, as 35
136		-	amended.amended, and other relevant federal law shall apply to health benefit plans. 36
137		-	…." 37
138		-	SECTION 3.3. The Revisor of Statutes shall replace the phrase "chemical 38
139		-	dependency" with the phrase "substance use disorder" in all of the following statutes: 39
140		-	(1) G.S. 58-51-16(a). 40
141		-	(2) G.S. 58-51-40(a). 41
142		-	(3) G.S. 58-51-55(b). 42
143		-	(4) G.S. 58-65-90(b). 43
144		-	(5) G.S. 58-67-75(b). 44
145		-	SECTION 3.4. All of the following are repealed: 45
146		-	(1) G.S. 58-51-50. 46
147		-	(2) Subdivision (a)(2) and subsection (c) of G.S. 58-51-55. 47
148		-	(3) G.S. 58-65-75. 48
149		-	(4) Subdivision (a)(2) and subsection (c) of G.S. 58-65-90. 49
150		-	(5) G.S. 58-67-70. 50
151		-	(6) Subdivision (a)(2) and subsection (c) of G.S. 58-67-75. 51 General Assembly Of North Carolina Session 2025
152		-	Page 4 House Bill 824-First Edition
153		-	SECTION 3.5. G.S. 58-3-192(a)(2) reads as rewritten: 1
154		-	"(2) Autism spectrum disorder. – As defined by the most recent edition of the 2
155		-	Diagnostic and Statistical Manual of Mental Disorders (DSM) or the most 3
156		-	recent edition of the International Statistical Classification of Diseases and 4
157		-	Related Health Problems. Autism spectrum disorder is not considered a 5
158		-	mental illness health condition, as defined in G.S. 58-3-220, 58-51-55, or a 6
159		-	mental illness, as defined in G.S. 58-51-55, 58-65-90, or 58-67-75." 7
160		-	SECTION 3.6.(a) G.S. 58-56-26 is amended by adding a new subsection to read: 8
161		-	"(e) Notwithstanding any provision of this Article to the contrary, all requirements relating 9
162		-	to the coverage of prescription drugs and pharmacy services under this Chapter that apply to 10
163		-	health benefit plans are applicable to a third-party administrator in the same way they are 11
164		-	applicable to an insurer." 12
165		-	SECTION 3.6.(b) Article 56A of Chapter 58 of the General Statutes is amended by 13
166		-	adding a new section to read: 14
167		-	"§ 58-56A-55. Health benefit plan requirements applicable. 15
168		-	All requirements relating to the coverage of prescription drugs and pharmacy services under 16
169		-	this Chapter that apply to health benefit plans are applicable to a pharmacy benefits manager in 17
170		-	the same way they are applicable to an insurer." 18
171		-	SECTION 3.7. This Part is effective when it becomes law and applies to insurance 19
172		-	contracts issued, amended, or renewed on or after that date. 20
173		-	21
174		-	PART IV. EFFECTIVE DATE 22
175		-	SECTION 4.1. Except as otherwise provided, this act is effective when it becomes 23
176		-	law. 24
	46	+	lawful scope of practice. 34
	47	+	(2) The health benefit plan would have covered the service if the service or 35
	48	+	procedure had been performed by another healthcare provider. 36
	49	+	H.B. 824
	50	+	Apr 8, 2025
	51	+	HOUSE PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
	52	+	Page 2 DRH30343-MR-58A
	53	+	(c) The participation of a pharmacy in a drug benefit provider network of a health benefit 1
	54	+	plan shall not satisfy any requirement that insurers offering health benefit plans include 2
	55	+	pharmacists in medical benefit provider networks." 3
	56	+	SECTION 1.1.(b) This section is effective October 1, 2025, and applies to insurance 4
	57	+	contracts issued, amended, or renewed on or after that date. 5
	58	+	6
	59	+	ACCEPT HEALTHCARE FACILITY CREDENTIALING FOR PHARMACISTS 7
	60	+	EMPLOYED BY THE FACILITY 8
	61	+	SECTION 1.2.(a) G.S. 58-3-230 is amended by adding a new subsection to read: 9
	62	+	"(d) Insurers that delegate credentialing agreements or requirements for pharmacists 10
	63	+	licensed under Article 4A of Chapter 90 of the General Statutes or the relevant laws of another 11
	64	+	state to a contracted healthcare facility shall accept the credentialing for all pharmacists employed 12
	65	+	by, or contracted with, those healthcare facilities." 13
	66	+	SECTION 1.2.(b) This section is effective October 1, 2025, and applies to insurance 14
	67	+	contracts issued, amended, or renewed on or after that date. 15
	68	+	16
	69	+	PART II. ENHANCE COVERAGE OF PRESCRIPTION DRUGS FOR OPIOID 17
	70	+	DISORDER AND OPIOID OVERDOSE UNDER HEALTH BENEFIT PLANS 18
	71	+	SECTION 2.1. G.S. 58-3-220 is amended by adding a new subsection to read: 19
	72	+	"(k) Select Prescription Drugs. – Insurers offering a health benefit plan shall provide 20
	73	+	coverage of all prescription drugs approved by the United States Food and Drug Administration 21
	74	+	for the treatment of opioid disorder and opioid overdose. If an insurer maintains one or more 22
	75	+	closed formularies, then all prescription drugs requiring coverage under this section shall be 23
	76	+	included on those formularies. The following shall apply to prescription drugs for which coverage 24
	77	+	is required under this subsection: 25
	78	+	(1) The prescription drug shall not be subject to prior authorization as a condition 26
	79	+	of coverage. 27
	80	+	(2) Pharmacies dispensing the prescription drug shall be reimbursed at the most 28
	81	+	recent National Average Drug Acquisition Cost price plus a dispensing fee. If 29
	82	+	the prescription drug dispensed is not available on the most recent National 30
	83	+	Average Drug Acquisition Cost price list, then the most recent Wholesale 31
	84	+	Acquisition Cost price plus a dispensing fee shall be used to reimburse 32
	85	+	pharmacies for dispensing the prescription drug." 33
	86	+	SECTION 2.2. This Part is effective October 1, 2025, and applies to insurance 34
	87	+	contracts issued, amended, or renewed on or after that date. 35
	88	+	36
	89	+	PART III. CONFORM TO FEDERAL LAW AND MAKE OTHER TECHNICAL 37
	90	+	CHANGES TO UPDATE THE GENERAL STATUTES THAT RELATE TO MENTAL 38
	91	+	HEALTH COVERAGE UNDER HEALTH BENEFIT PLANS 39
	92	+	SECTION 3.1.(a) Subsections (b), (c), (d), and (j) of G.S. 58-3-220 are repealed. 40
	93	+	SECTION 3.1.(b) Subsection (h) of G.S. 58-3-220 is recodified as subsection (a1) 41
	94	+	of G.S. 58-3-220. 42
	95	+	SECTION 3.2. G.S. 58-3-220, as amended by Part II and Section 3.1 of this act, 43
	96	+	reads as rewritten: 44
	97	+	"§ 58-3-220. Mental illness health benefits coverage. 45
	98	+	(a) Mental Health Equity Requirement. – Except as provided in subsection (b), an insurer 46
	99	+	shall provide in each group health benefit plan benefits for All health benefit plans shall provide 47
	100	+	coverage for the necessary care and treatment of mental illnesses health conditions that are no 48
	101	+	less favorable than benefits for the necessary care and treatment of physical illness generally, 49
	102	+	including application of the same limits. For purposes of this subsection, mental illnesses are as 50
	103	+	diagnosed and defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, or 51 General Assembly Of North Carolina Session 2025
	104	+	DRH30343-MR-58A Page 3
	105	+	a subsequent edition published by the American Psychiatric Association, except those mental 1
	106	+	disorders coded in the DSM-5 or subsequent edition as autism spectrum disorder (299.00), 2
	107	+	substance-related disorders (291.0 through 292.2 and 303.0 through 305.9), those coded as sexual 3
	108	+	dysfunctions not due to organic disease (302.70 through 302.79), and those coded as "V" codes. 4
	109	+	For purposes of this subsection, "limits" includes deductibles, coinsurance factors, co-payments, 5
	110	+	maximum out-of-pocket limits, annual and lifetime dollar limits, and any other dollar limits or 6
	111	+	fees for covered services.health conditions. 7
	112	+	(a1) Definitions. – As used The following definitions apply in this section: 8
	113	+	(1) "Health benefit plan" has the same meaning as Health benefit plan. – As 9
	114	+	defined in G.S. 58-3-167. 10
	115	+	(2) "Insurer" has the same meaning as Insurer. – As defined in G.S. 58-3-167. 11
	116	+	(3) Medical necessity. – As defined in G.S. 58-50-61. 12
	117	+	(4) "Mental illness" has the same meaning as in G.S. 122C-3(21), with a Mental 13
	118	+	health condition. – A mental disorder defined in the Diagnostic and Statistical 14
	119	+	Manual of Mental Disorders, DSM-5, or subsequent editions published by the 15
	120	+	American Psychiatric Association, except this term does not include those 16
	121	+	mental disorders coded in the DSM-5 or subsequent editions as autism 17
	122	+	spectrum disorder (299.00), substance-related disorders (291.0 through 292.9 18
	123	+	and 303.0 through 305.9), those coded as sexual dysfunctions not due to 19
	124	+	organic disease (302.70 through 302.79), and those coded as "V" codes. 20
	125	+	… 21
	126	+	(g) Utilization Review. – Nothing in this section prevents an insurer from applying 22
	127	+	utilization review criteria to determine medical necessity as defined in G.S. 58-50-61 as long as 23
	128	+	it does so in accordance with all requirements for utilization review programs and medical 24
	129	+	necessity determinations specified in that section, including the offering of an insurer appeal 25
	130	+	process and, where applicable, health benefit plan external review as provided for in Part 4 of 26
	131	+	Article 50 of Chapter 58 of the General Statutes.in accordance with G.S. 58-50-61. 27
	132	+	… 28
	133	+	(i) Notwithstanding any other provisions of this section, a group health benefit plan that 29
	134	+	covers both medical and surgical benefits and mental health benefits shall, with respect to the 30
	135	+	mental health benefits, comply with all Federal Law Applies. – All applicable standards of 31
	136	+	Subtitle B of Title V of Public Law 110-343, known as the Paul Wellstone and Pete Domenici 32
	137	+	Mental Health Parity and Addiction Equity Act of 2008, and the applicable regulations, as 33
	138	+	amended.amended, and other relevant federal law shall apply to health benefit plans. 34
	139	+	…." 35
	140	+	SECTION 3.3. The Revisor of Statutes shall replace the phrase "chemical 36
	141	+	dependency" with the phrase "substance use disorder" in all of the following statutes: 37
	142	+	(1) G.S. 58-51-16(a). 38
	143	+	(2) G.S. 58-51-40(a). 39
	144	+	(3) G.S. 58-51-55(b). 40
	145	+	(4) G.S. 58-65-90(b). 41
	146	+	(5) G.S. 58-67-75(b). 42
	147	+	SECTION 3.4. All of the following are repealed: 43
	148	+	(1) G.S. 58-51-50. 44
	149	+	(2) Subdivision (a)(2) and subsection (c) of G.S. 58-51-55. 45
	150	+	(3) G.S. 58-65-75. 46
	151	+	(4) Subdivision (a)(2) and subsection (c) of G.S. 58-65-90. 47
	152	+	(5) G.S. 58-67-70. 48
	153	+	(6) Subdivision (a)(2) and subsection (c) of G.S. 58-67-75. 49
	154	+	SECTION 3.5. G.S. 58-3-192(a)(2) reads as rewritten: 50 General Assembly Of North Carolina Session 2025
	155	+	Page 4 DRH30343-MR-58A
	156	+	"(2) Autism spectrum disorder. – As defined by the most recent edition of the 1
	157	+	Diagnostic and Statistical Manual of Mental Disorders (DSM) or the most 2
	158	+	recent edition of the International Statistical Classification of Diseases and 3
	159	+	Related Health Problems. Autism spectrum disorder is not considered a 4
	160	+	mental illness health condition, as defined in G.S. 58-3-220, 58-51-55, or a 5
	161	+	mental illness, as defined in G.S. 58-51-55, 58-65-90, or 58-67-75." 6
	162	+	SECTION 3.6.(a) G.S. 58-56-26 is amended by adding a new subsection to read: 7
	163	+	"(e) Notwithstanding any provision of this Article to the contrary, all requirements relating 8
	164	+	to the coverage of prescription drugs and pharmacy services under this Chapter that apply to 9
	165	+	health benefit plans are applicable to a third-party administrator in the same way they are 10
	166	+	applicable to an insurer." 11
	167	+	SECTION 3.6.(b) Article 56A of Chapter 58 of the General Statutes is amended by 12
	168	+	adding a new section to read: 13
	169	+	"§ 58-56A-55. Health benefit plan requirements applicable. 14
	170	+	All requirements relating to the coverage of prescription drugs and pharmacy services under 15
	171	+	this Chapter that apply to health benefit plans are applicable to a pharmacy benefits manager in 16
	172	+	the same way they are applicable to an insurer." 17
	173	+	SECTION 3.7. This Part is effective when it becomes law and applies to insurance 18
	174	+	contracts issued, amended, or renewed on or after that date. 19
	175	+	20
	176	+	PART IV. EFFECTIVE DATE 21
	177	+	SECTION 4.1. Except as otherwise provided, this act is effective when it becomes 22
	178	+	law. 23