Part I.

Enacts GS 58-3-241 defining healthcare services and pharmacist. Requires health benefit plans offered by insurers in the state to cover healthcare services provided by a pharmacist if the service or procedure was performed within the pharmacist’s licensed, lawful scope of practice and the plan would have covered the service or procedure if it had been performed by another healthcare provider. Clarifies that pharmacy participation in a drug benefit provider network of a health benefit plan does not satisfy any requirement that insurers offering health benefit plans include pharmacists in medical benefit provider networks. Effective October 1, 2025, and applies to insurance contracts issued, amended, or renewed on or after that date.

Amends GS 58-3-230 by adding subsection (d), which requires insurers that delegate credentialing agreements or requirements for pharmacists licensed under GS Chapter 90, Article 4A or relevant laws of another state to a contracted healthcare facility to accept the credentialing for all pharmacists employed by, or contracted with, those healthcare facilities. Effective October 1, 2025, and applies to insurance contracts issued, amended, or renewed on or after that date.

Part II.

Amends GS 58-3-220 by adding subsection (k) requiring insurers that offer a health benefit plan to provide coverage of all prescription drugs approved by the United States Food and Drug Administration for opioid disorder and opioid overdose treatment. Mandates that all prescription drugs required by this statute be included on any closed formularies an insurer maintains. Prohibits prescription drugs that must be covered under this subsection from being subject to prior authorization as a condition of coverage and requires pharmacies dispensing the drugs to be reimbursed the amount as detailed. Effective October 1, 2025, and applies to insurance contracts issued, amended, or renewed on or after that date.

Part III.

Repeals subsections (b), (c), (d), and (j) of GS 58-3-220, which concerned group health benefit plans’ minimum required benefits for mental illness benefits coverage, including durational limitations for certain mental illnesses and clarifying language that an insurer could provide greater than the minimum.

Recodifies GS 58-3-220(h) as GS 58-3-220(a1).

Rewrites GS 58-3-220, as amended above in Parts II and III, by making conforming changes and making technical changes to refer to mental illness as mental health, mental illnesses as mental health conditions, and physical illness as physical health conditions. Removes subsection definitions of mental illnesses and limits. Makes technical changes to definitions in newly recodified GS 58-3-220(a1) and changes the term mental illness to mental health condition, removes substance related disorders from the listed mental disorders the term does not include. Makes clarifying and technical changes to subsection (g), concerning utilization review, and subsection (i) making clear that listed federal law applies and adding clarifying language that all other relevant federal law applies to health benefit plans.

Requires the Revisor of Statutes to replace the phrase “chemical dependency” with the phrase “substance use disorder” in GS 58-51-16(a);  GS 58-51-40(a); GS 58-51-55(b); GS 58-65-90(b); GS 58-67-75(b).

Repeals GS 58-51-50, concerning requirements for insurers’ coverage for chemical dependency treatment. Repeals GS 58-51-55(a)(2), which defined chemical dependency, and GS 58-51-55(c), which clarified that chemical dependency coverage was only required by insurers as provided in GS 58-51-50.

Repeals GS 58-65-75, concerning required coverage for chemical dependency treatment by group insurance certificate or group subscriber contract under any hospital or medical plan covered by Articles 65 and 66 of Chapter 58. Repeals GS 58-65-90(a)(2), which defined chemical dependency, and GS 58-65-90(c), which clarified that chemical dependency coverage was only required for service corporations as provided in GS 58-65-75.

Repeals GS 58-67-70, concerning required coverage for chemical dependency treatment by health maintenance organizations that write healthcare plans on a group basis and is subject to Article 67. Repeals GS 58-67-75(a)(2), which defined chemical dependency, and GS 58-67-75(c), which clarified that chemical dependency coverage was only required for health maintenance organizations as provided in GS 58-67-70.

Makes conforming changes to GS 58-3-192(a)(2).

Adds new subsection (e) to GS 58-56-26 making all requirements related to the coverage of prescription drugs and pharmacy services under GS Chapter 58 applicable to health benefit plans also applicable to a third-party administrator in the same way they are applicable to an insurer.

Enacts GS 58-56A-55 making all requirements related to the coverage of prescription drugs and pharmacy services under GS Chapter 58 applicable to health benefit plans also applicable to a pharmacy benefits manager in the same way they are applicable to an insurer.

Part III is effective when the act becomes law and applies to insurance contracts issued, amended, or renewed on or after that date.