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Old North State Report
May 9, 2025
Old North State Report – May 9, 2025
UPCOMING EVENTS
May 13, 2025
NC Chamber Business Summit on Mental Health
May 16, 2025
June 5, 2025
Triangle Business Journal 2025 State of Health Care in the Triangle
July 16-July 28, 2025
North Carolina Healthcare Association Summer Meeting
LEGISLATIVE NEWS
CROSSOVER DEADLINE
State lawmakers passed a torrent of bills from the House of Representatives to the Senate and vice versa before their crossover deadline. Any bill not passing one chamber by May 8 is considered dead until the next session. The work ended on Wednesday with the House adjourning last at around 7 p.m. after passing 28 bills.
The Senate passed 20 bills Wednesday, including one allowing authorized individuals to carry guns at private schools and another protecting parents from charges if they do not support their transgender child's identity.
Out of 1,800 bills filed this year, about 350 have passed from one chamber to another, with only one, a Hurricane Helene relief package, becoming law.
Some bills that moved forward include:
- easier access to ivermectin (House Bill 618);
- a ban on most homeless camps (House Bill 781);
- allowing private school teachers to carry concealed handguns (Senate Bill 280);
- lifetime concealed-carry permits (House Bill 674);
- new prescription drug market regulations (Senate Bill 479);
- changes to high school math and social studies requirements (House Bill 415);, and
- protection for parents against gender-affirming care for their children (Senate Bill 442).
In the coming days, both chambers will review each other's bills to decide on future actions.
Read more by The News & Observer
THE SCRIPT ACT
Senate Bill 479 was passed unanimously by the Senate on Wednesday. Sponsors say the bill aims to support independent pharmacies and increase transparency with new regulations. Senator Benton Sawrey (R-Johnson) called it a major reform in the way the prescription drug market is regulated in North Carolina.
In late April, the House also passed a pharmacy-related bill focused on reforming the industry, mainly targeting pharmacy benefit managers (PBMs). The House bill bans spread pricing, where PBMs charge insurers more for a drug than what they reimburse pharmacies, keeping the difference. It also limits the fees PBMs can charge pharmacies and prevents favoritism towards PBM-affiliated pharmacies.
The complicated pharmaceutical distribution system involves various players. Drug manufacturers create drugs and sell them to wholesalers or pharmacies. Wholesalers then distribute these medications to customers, including pharmacies. PBMs function as middlemen negotiating deals with manufacturers and wholesalers on behalf of health plans, and pharmacies work with PBMs to access networks and get reimbursements.
Independent pharmacies often struggle due to low reimbursements from PBMs and insurance plans. Some PBMs, like CVS Caremark, are connected to large retail chains and have been accused of directing customers to their own pharmacies.
The Senate bill would regulate multiple industry players, forbidding PBMs from reimbursing pharmacies in underserved areas at rates lower than their drug acquisition costs. It would also require Pharmacy Services Administrative Organizations (PSAOs), on which independent pharmacies often rely, to be licensed and regulated. Additionally, the State Health Plan would need to consider adopting these new provisions in its PBM contract, with CVS Caremark as its current PBM.
Read more by The News & Observer
BREAST CANCER AND BIOMARKER SCREENINGS
The state House voted on Wednesday to require insurance companies to cover more testing for breast cancer and other diseases. One bill, House Bill 297, mandates insurance companies to cover supplemental breast cancer exams like they do for mammograms. Supporters believe patients avoid these tests due to high costs, often over $1,000, even with insurance. A similar bill from two years ago passed the House, but was never considered by the Senate.
Another bill, House Bill 567, passed the House with nearly unanimous support and requires coverage for biomarker testing, which helps diagnose diseases like cancer and Alzheimer’s. Representative Pricey Harrison (D-Guilford) shared her positive experience with biomarker testing, noting its potential to influence treatment decisions.
Both bills now go to the Senate, which recently passed a bill to limit new insurance coverage mandates. Supporters claim that requiring insurance plans to cover specific services increases costs, and if it passes, lawmakers would need to review and repeal an existing mandate.
EMERGENCY AMBULANCE TRANSPORTATION
On Tuesday, the House passed House Bill 489 unanimously. The measure seeks to protect residents from high ambulance bills by ensuring insurance companies accept rates set by local governments. The bill mandates that health-insurance plans cover out-of-network emergency ambulance services without needing prior authorization in emergencies. It passed with a 111-0 vote, aiming to relieve citizens from unexpected costs for services beyond their control.
Representative Donnie Loftis (R-Gaston) noted that over half of ambulance rides involve out-of-network fees and that 8% of U.S. medical debt comes from ground ambulances. The bill ensures that insurers honor rates set by counties for emergency medical services. A minimum reimbursement rate of 100% of local government-approved rates is established, or 400% of the Medicare rate if no local rate exists. Loftis emphasized that citizens should not bear these costs since they already fund EMS services through taxes. The bill aligns with findings from a 2024 congressional advisory committee recommending that insurers accept state and local EMS rates.
COMPENSATION REGULATION AND VETERANS’ BENEFITS
The North Carolina Senate has approved Senate Bill 693, entitled “Veteran Access, Liberty, Options for Recovery. ” This bill aims to regulate how for-profit companies charge veterans for assistance in applying for federal benefits. Many of these companies, including one in Pinehurst, have recently received cease and desist letters from the U.S. Department of Veterans Affairs for not following federal laws.
Currently, it is illegal for unaccredited agents and organizations to charge veterans for help with benefits, but there are no criminal penalties for those who do. Senate Bill 693 seeks to protect veterans by prohibiting aggressive targeting by these companies and restricting access to veterans’ passwords and medical data. The bill also prevents companies from arranging medical exams for disability claims from professionals they employ.
Additionally, the bill mandates that contracts between veterans and claim companies must include a clear disclosure stating that the company is not affiliated with the VA, and that other organizations can provide similar services for free. This disclosure must be printed in 12-point font and be clearly visible.
Senator Val Applewhite (D-Cumberland), a veteran and one of the bill’s sponsors, emphasized that this is an important step for consumer protection and expressed the need for further measures to safeguard veterans from exploitation by these companies. On May 6, the bill passed the required three readings in the Senate before being sent to the House.
CHANGE TO INSURANCE LICENSING LAW
House Bill 737, which aims to eliminate the educational course requirements for insurance agent licenses, has been passed by the North Carolina House and sent to the Senate. The bill is intended to address the reported shortage of insurance producers in the state.
Representative Chris Humphrey (R-Greene), the bill’s sponsor and an insurance agent, highlighted the difficulty of a 40-hour course. Under House Bill 737, producers would still need to pass the licensing exam, but they could opt for online preparatory classes or choose not to take any at all.
Charles Whitehead, an attorney with the state Department of Insurance, pointed out that most people who skip online courses do not pass the exam. Several other states have recently eliminated similar course requirements, and the bill has the support of the Independent Insurance Agents of North Carolina.
Humphrey argued that removing the pre-licensing education course requirements would make it easier for individuals to become licensed and help alleviate the agent shortage. The bill would prevent state regulators from changing education requirements.
Read more by Insurance Journal (Rabb) 4/17/25
INSURANCE REBATE LAW
House Bill 356, which would clarify permitted trade practices with respect to insurance rebates, has been passed by the North Carolina House and sent to the Senate.
The bill aims to clarify that certain actions are not deemed unfair discrimination or illegal rebates under G.S. 58-63-15. These include (1) offering value added products or services that are not specified in the insurance policy at no or reduced cost if the product or service relates to the insurance coverage and meets other specified criteria; and (2) providing gifts or services under $250 per policy term without being a requirement for policy continuation. It also allows non-financial raffle drawings open to the public and under specified conditions, and confirms these practices are not illegal rebates.
The additional insurance purchase incentive ban will start on January 1, 2027, with other provisions effective upon the law's enactment.
The National Association of Insurance Commissioners provided the bill's framework.
Read more by North Carolina General Assembly
WHAT WE’RE LISTENING TO
- Under the Dome Podcast
- Do Politics Better Podcast
- WUNC Politics Podcast
- Carolina Newsmakers Podcast
- NC Capitol Wrap Podcast
WHAT WE’RE READING
GET IN TOUCH
These materials have been prepared for informational purposes only and are not legal advice. This information is not intended to create, and receipt of it does not constitute, an attorney-client relationship. Internet subscribers and online readers should not act upon this information without seeking professional counsel.