House Bill 163 would crack down on pharmacy benefit managers, the middlemen between pharmacists and insurers.
CHARLOTTE, N.C. — A bill advancing through the North Carolina General Assembly this week could significantly impact prescription drug costs for consumers, with many believing it will lead to lower prices.
House Bill 163, which cleared the House with bipartisan support Tuesday, would crack down on pharmacy benefit managers, or PBMs, the middlemen between pharmacists and insurers.
The legislation would ban “spread pricing,” where PBMs charge insurers more than they pay pharmacies, and require them to pass drug discounts directly to patients.
Dr. Martez Prince, who runs Premier Pharmacy and Wellness Center in east Charlotte, supports the measure.
“We’ve been here for nine years, and we see the industry is a roller coaster, and that roller coaster a lot of the time, is directly reflective of those PBMs or the prescription side of the insurance plans,” Prince said. “They aren’t even covering the cost of a medication, so that’s leaving the pharmacy in a negative.”
However, critics warn the bill could potentially backfire.
“North Carolina is already listed as one of the highest cost health care states in the country. We think this bill would exacerbate that problem,” said Connor Rose, the North Carolina expert from the Pharmaceutical Care Management Association, the national trade association for PBMs. “We also think that this bill takes away choices that we offer employers in designing prescription drug benefit plans that would reduce access, reduce quality, and increase costs.”
Rose argues similar laws haven’t worked in other states.
“When employers and health plans and insurers are going to have to try to mitigate the impact of this bill, that may mean higher premiums, that may mean higher cost sharing,” Rose said. “If you have a high-deductible health plan and you haven’t hit your deductible, you’re going to be responsible potentially for that $10 dispensing fee out of your pocket.”
The bill excludes the state health plan, which Rose says is another red flag. During House floor discussions, multiple representatives agreed. Rep. Heather Rhyne, a Republican from Lincoln County who sponsored the bill, said she has concerns about prescription costs.Â
 “I do have concerns and would love to continue that conversation and that fight, but I think that’s a different fight for a different day,” Rhyne explained.Â
For Prince, however, the bill represents progress toward fairness and a way to let consumers choose their pharmacy without penalties or limits.
“This bill is going to give fairness across the board, allow individuals to choose whatever forms they want to go to, while the pharmacies are being reimbursed fairly and consumers are seeing transparent pricing,” Prince said. “Pharmacies across the board really deserve this. Consumers deserve this.”
The bill is currently in the state Senate, having passed its first reading and is now headed to committee.
Contact Julie Kay at juliekay@wcnc.com and follow her on Facebook, X and Instagram.
