In a firm stance against opaque dealings in prescription drug management, North Carolina's Insurance Commissioner Mike Causey and Attorney General Jeff Jackson have crafted a missive to the managers who sit at the nexus of pharmacies, insurers, and consumers: the Pharmacy Benefits Managers (PBMs). This letter outlines the expectations and mandates laid out by the freshly minted SCRIPT Act—a piece of legislation passed just last year that aims to recalibrate the operational guidelines of PBMs in the state.
The SCRIPT Act, as reported by the North Carolina Department of Insurance, arms both the DOI and the Department of Justice with broader authority to oversee, investigate, and if necessary, prosecute PBMs over any practices that veer toward deception or anti-competitive behavior. These efforts underscore North Carolina's endeavors to foster a landscape of transparency, stability, and fairness within its insurance market.
Of the many notes struck in the letter, distinct emphasis is placed on the protections for consumers and pharmacies outlined in the SCRIPT Act. “North Carolina’s SCRIPT Act represents a shift toward PBM transparency, accountability and consumer protections,” wrote Commissioner Causey and Attorney General Jackson. They mandated that PBMs permit all willing pharmacies to participate in their networks, and they further decreed that consumers cannot be bound to purchase drugs solely from mail-order pharmacies.
Additionally, the SCRIPT Act dictates fair play in the financial arena. Independent pharmacies, especially those operating in pharmacy deserts, must see reimbursement rates that are no less than the acquisition cost for the drugs or services provided. With 23 PBMs already licensed in North Carolina and another four waiting in the wings, these regulatory changes have the potential to reverberate throughout the state's healthcare system.
The commissioner and attorney general were unequivocal in their closing remarks on enforcing these new rules: "The NCDOI and NCDOJ will uphold the legislative mandate of the General Assembly and, where warranted, will pursue all available remedies under law."
