North Carolina lawmakers considering major health insurance changes

Health insurance - Changes Coming

At the same time, they are also considering substantial changes to the prescription drug industry.

A number of bills are currently moving forward in North Carolina with the intention of overhauling components of the health insurance and pharmacy industries.

Powerful companies are pushing hard in the hopes of securing regulations in their favor.

The changes to the laws in the state would include those regulating Blue Cross Blue Shield of North Carolina, the largest health insurance company in the state. Those have already made it through their first committee, though the vote was divided. A separate bill governing pharmacy benefit managers also moved forward. Those are used by large insurers to negotiate drug prices. This is only the latest step in a battle between those groups and independent pharmacies across the state that has been continuing for years.

Health insurance - People at pharmacy

Lawmakers have also been considering a measure that would accelerate the process of prior authorization used by insurers to decide whether medical care will be covered. That measure has also made it through the House Health Committee.

House Bill 246, the bill that would regulate pharmacy benefit managers (PMBs), also intends to ban several tactics such as “spread pricing”, which PMBs use to even out drug prices which would otherwise vary from one pharmacy to the next. According to independent pharmacists, PMBs, which process around 80 percent of US prescriptions, use anti-competitive practices as pharmaceutical industry middlemen in order to drive up profits.

The health insurance and pharmacy industry bills are aiming to keep prices controlled.

Pharmacist Rep. Wayne Sasser said that the largest of the PMBs made over $14 billion in 2022.

“Pretty evident most of that money’s not flowing through to the rate payers,” said Sasser (R-Stanly).

According to health insurance companies, they use PMBs to keep drug costs controlled, and costs would rise if the bill passes.

“We negotiate discounts with drug manufacturers, we negotiate discounts with pharmacies,” said Pharmaceutical Care Management Association lobbyist Connor Rose. “We’re the only entity in the supply chain whose role it is to reduce drug prices.”

There remains a long road before these bills could become law and it remains unclear whether they will be able to pass each stage along the way.

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