SB 257 – Medication Cost Transparency Act

Primary Senate Sponsors: Sen. Jim Perry (R-Lenoir, Wayne); Sen. Danny Earl Britt, Jr. (R-Columbus, Robeson); Sen. Todd Johnson (R-Union)



This bill:

  • Expands the definition of pharmacy benefits manager to include new functions including negotiating rebates with manufactures, processing claims for prescription drugs or medical supplies, providing retail network management for pharmacies or pharmacists, and paying pharmacies or pharmacists for prescription drugs or medical supplies.
  • Prohibits any person or organization from operating as a pharmacy benefits manager for health benefit plans without obtaining a license from the Commissioner of the Department of Insurance.
  • Prohibits a pharmacy benefits manager from prohibiting a pharmacist/pharmacy from charging a minimal shipping and handling fee to the insured for a mailed prescription if the pharmacist/pharmacy discloses the fee, the fee may not be reimbursed by the health benefit plan, insurer, or pharmacy benefits manager, and the charge is agreed to by the health benefit plan or pharmacy benefits manager.
  • Adds certain statutory protections for pharmacies and pharmacists.
  • Requires pharmacy benefits managers to ensure dispensing fees are not included in the calculation of maximum allowable cost price for a prescription drug.
  • Requires pharmacy benefits managers to establish an administrative appeals procedure for contracted pharmacies/pharmacists to appeal the provider’s reimbursement for a prescription drug subject to maximum allowable cost pricing if the amount of reimbursement for the drug is less than the net amount that the network provider paid to the supplier of the drug.
  • Establishes a series of requirements for pharmacy benefits manager networks.
  • Prohibits pharmacy benefits managers from transferring or sharing prescription information records containing patient-identifiable and prescriber-identifiable data to a pharmacy benefits manager affiliate in a way that is prohibited by HIPAA.


Filed – 3/11/2021