In August, North Carolina’s Governor signed the SCRIPT Act into law, regulating PBM transparency and strengthening consumer and pharmacy protections. Texas extended the time for new parents to enroll their newborns in coverage from 31 to 60 days from the date of birth. Employers prepare to send out Medicare Part D Creditable Coverage letters to applicable individuals. Illinois expands dependent coverage rules to eligible dependent parents and stepparents of insured employees.
NORTH CAROLINA PASSES NEW PBM LAW
On July 10, 2025, North Carolina Governor Josh Stein signed into law the Act Supporting Community Retail Pharmacies and Improving Transparency (“the SCRIPT Act”). The sweeping law regulating pharmacy benefit managers (PBMs) in North Carolina is designed to improve transparency, strengthen consumer protections, and support community pharmacies. While most provisions take effect October 1, 2025, others will be phased in through 2026 and 2027.
Key elements of the law:
- Participants have the freedom to use any in-network pharmacy. PBMs cannot limit access, reduce reimbursements, impose extra costs, or force members into mail-order programs.
- Starting October 2026, organizations that negotiate on behalf of independent pharmacies must avoid restrictive practices, such as steering pharmacies to certain wholesalers.
- PBMs will face detailed reporting requirements on rebates, fees, and pricing practices. Reports must be submitted to the state insurance commissioner for contracts effective October 1, 2025.
- PBMs cannot pay independent pharmacies less than affiliated pharmacies for the same services. Pharmacies in underserved areas must receive at least acquisition cost reimbursement.
- Effective January 1, 2027, 90% of manufacturer rebates must be passed directly to patients at the point of sale. Carriers must submit annual compliance attestations.
- Drug manufacturers must disclose major price increases beginning January 2026 and notify interested parties of the cost of any new drug as soon as it becomes available.
The SCRIPT Act applies broadly to state-regulated health plans, including fully insured coverage. However, the extent to which these rules apply to self-funded ERISA plans remains uncertain. Recent court rulings highlight that states may regulate pharmacy reimbursements but cannot dictate plan design.
EMPLOYER CONSIDERATIONS
No immediate action is needed for fully insured plans. Insurance carriers will ensure compliance with the law. Employers with self-funded plans should work with their PBM or third-party administrator to understand whether any changes will be necessary given the evolving ERISA preemption landscape.
