GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1999

H	1 

HOUSE BILL 1855

Short Title:  State Health Plan Changes.	(Public)

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Sponsors: Representatives Wright; Hurley and Wainwright.

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Referred to:  Health.

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May 30, 2000

A BILL TO BE ENTITLED
AN ACT PERTAINING TO PRESCRIPTION DRUG COSTS UNDER THE TEACHERS' AND STATE EMPLOYEES' COMPREHENSIVE MAJOR MEDICAL PLAN.
The General Assembly of North Carolina enacts:
Section 1.  G.S. 135-40.5(g) reads as rewritten:
"§ 135-40.5. Benefits not subject to deductible or coinsurance.
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(g)	Prescription Drugs. – The Plan's allowable charges for prescription legend drugs to be used outside of a hospital or skilled nursing facility are determined by a third-party pharmacy benefit manager under contract with the Plan. The Plan will pay allowable charges for each outpatient prescription drug less a copayment to be paid by each covered individual equal to the following amounts: pharmacy charges up to ten dollars ($10.00) for each generic prescription, fifteen dollars ($15.00) for each branded prescription, and twenty dollars ($20.00) for each branded prescription with a generic equivalent drug. By accepting the copayments and any remaining allowable charges provided by this subsection, pharmacies shall not balance bill an individual covered by the Plan. A prescription legend drug is defined as an article the label of which, under the Federal Food, Drug, and Cosmetic Act, is required to bear the legend: 'Caution: Federal Law Prohibits Dispensing Without Prescription.' Such articles may not be sold to or purchased by the public without a prescription order. Benefits are provided for insulin even though a prescription is not required."
Section 2. G.S. 135-39.5 is amended by adding the following new subdivision to read:
"(24)	Implementing and administering a case management and disease management program."
Section 3.  This act is effective when it becomes law.