HB 896 – Fair & Equitable Reimbursement/Pharmacists

Primary House Sponsors: Rep. Mitchell Setzer (R-Catawba)



This bill requires health benefit plans offered by insurers in NC to reimburse a pharmacist at the same rate that other health care providers are reimbursed when providing the same or equivalent health care services or procedures as long as 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 provided reimbursement if the service or procedure had been performed by another health care provider; and (3) the pharmacist provided the service or procedure in compliance with any requirements of the insurer related to the service or procedure.


This bill also requires insurers offering health benefit plans in NC that delegate credentialing agreements to contracted health care facilities to accept credentialing for pharmacists employed or contracted with those facilities.


This bill also requires insurers offering health benefit plans in NC to reimburse a contracted health care facility or a contracted pharmacist directly for covered services performed by a pharmacist within that pharmacist’s lawful scope of practice regardless of whether the pharmacist is a participating provider in the insurer’s provider network.


This bill also appropriates $100K in nonrecurring funds for the 2021-2022 fiscal year to the Department of Insurance to be used for implementation of the above provisions.



Filed – 5/5/2021