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Overly Restrictive Prescription Plans

RESOLVED, That the North Carolina Medical Society supports legislation that would require insurance companies, managed care organizations, pharmacy benefit management plans and utilization review organizations to describe pharmaceutical or drug plans in insurance policies or contracts in language understandable to the average layperson including:

  • The inclusion of any drug formularies and the process of selecting drugs to be used on such formularies,
  • The inclusion of any “tiered” formulary programs requiring higher co-payments for certain drugs and the process for selecting drugs to be used in such tiers,
  • The inclusion of any “step” programs requiring use of one drug prior to the use of another subsequent drug and the process for selection of drugs in the step program, and
  • An explicit list of drugs requiring preauthorization and the process for enrollees to use to obtain such preauthorization.

(Report J-2000, adopted 11/12/00)
(revised, Report R-2006, Item 60, adopted 10/29/2006)
(reaffirmed, Report H-2011, Item 3-3, 10/23/2011)
(reaffirmed, Board Report-2018, Item 92, adopted 11/3/2018)