Senate committee substitute to the 1st edition makes the following changes.
Changes the definition of CLIA-waived test under GS 90-85.3 so that it now means a laboratory test authorized by the FDA and waived under the Clinical Laboratory Improvement Amendments of 1988.
Amends GS 90-85.3A to also allow a pharmacist to order and perform a CLIA-waived test for streptococcus infections; also clarifies that a pharmacist may initiate treatment for both the flu and streptococcus infections based on the results of the CLIA-waived test. Adds to the requirement that a health benefit plan cover services provided by a pharmacist when the two specified conditions are met, that the coverage must be at no less than the same rate as any other healthcare provider performing the same service. Adds that an insurer must accept a claim under the statute regardless of whether it is submitted by a pharmacist or a pharmacy submitting the claim on behalf of a pharmacist the pharmacy employs or contracts with.
Removes the current provision requiring the State Health Director to consult with the Board of Pharmacy and Medical Board in developing statewide protocols for implementing the changes to GS 90-85.3A. Instead, requires the Medical Board and Board of Pharmacy, by October 1, 2025, to adopt rules to implement Section 1 of this act, which contains the changes to GS 90-85.3 and GS 90-85.3A, including at least the five specified measures, including an approved course of treatment pharmacists can implement for the flu and streptococcus infections, and patient parameters necessitating referral to a primary, urgent, or emergency care provider.
Changes the act’s short title.
Bill Summaries: S335 (2025-2026 Session)
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Bill S 335 (2025-2026)Summary date: Apr 2 2025 - View summary
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Bill S 335 (2025-2026)Summary date: Mar 19 2025 - View summary
Amends GS 90-85.3A to allow a pharmacist to (1) administer drugs and (2) order and perform a CLIA-waived test to treat influenza in accordance with statewide protocols. Prohibits a pharmacist from treating a health condition under GS 90-85.3A with any controlled Schedule 1-IV controlled substance. Defines CLIA-waived test as a lab test approved by the FDA and determined by the Centers for Medicare and Medicaid Services to qualify for a waiver under the federal Clinical Laboratory Improvement Amendments of 1988 and safe for use in non-laboratory settings. Effective October 1, 2025.
Enacts GS 58-3-241, requiring health benefit plans to cover healthcare services provided by pharmacists if (1) the service or procedure was performed within the pharmacist’s licensed scope of practice and (2) the health benefit plan would have covered the service if it had been performed by another healthcare provider. Defines healthcare provider, healthcare services, and pharmacist. Specifies that the participation of a pharmacy 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. Applies all requirements relating to coverage of prescription drugs and pharmacy services under GS Chapter 58 governing health benefit plans to third-party administrators as well as insurers. Amends GS 58-3-230 (uniform provider credentialing) to require insurers that delegate credentialing agreements or requirements for pharmacists licensed under Article 4A of GS Chapter 90 of the General Statutes or the relevant laws of another state to a contracted healthcare facility shall accept the credentialing for all pharmacists employed by, or contracted with, those healthcare facilities. Amends GS 58-3-200 (pertaining to miscellaneous insurance requirements) to require, upon notice or request from the insured, for the insurer to determine whether a healthcare provider able to meet the needs of the insured is available to the insured without unreasonable delay by reference to the insured's location and the specific medical needs of the insured. Effective October 1, 2025, and applies to insurance contracts entered into, renewed, or amended on or after that date.
Requires the State Health Director, in consultation with the NC Board of Pharmacy and Medical Board to develop statewide protocols relating to the modifications to GS 90-85.3A discussed above, including patient parameters necessitating referral to a primary, urgent, or emergency care provider.