If you care about the cost of healthcare and prescription drugs in North Carolina, then there are two active legislative proposals you should be very concerned about.

Both will make healthcare more expensive and less safe for businesses, workers, and their families.  

PBM “Reform” – House Bill 246

Some PBM reform is good. The Affordable Healthcare Coalition scored and supported PBM reforms in the past.

HB246, however, isn’t one that will help consumers save money or increase transparency.

Instead, this bill is about increasing financial returns for pharmacies and drug manufacturers at the expense of consumers.

The bill:

  • Creates a new Pharmacy Tax on consumers which will raise the cost of every prescription you fill. The bill increases dispensing fees by as much as 1000 percent. There is no added benefit to the consumer. This is a financial windfall for the big pharmacy chains.
  • Includes mandates that would lead to higher drug costs.
  • Removes the ability to reimburse pharmacies based on quality and outcomes.

Experts have already warned us about the impacts of misguided PBM laws. This is exactly kind of bill they are talking about.

PBM reforms passed by the General Assembly in 2021 have not even been fully implemented yet. Those reforms should be allowed to happen. Then the focus should turn to lowering drug costs for consumers.    

Optimization Reviews – House Bill 649

Prior authorizations, or optimization reviews as they are more accurately described, serve as safety and costchecks for patients.

For example, they can stop the over-prescribing of opioids, or flag that a patient is on a separate medication that has a dangerous interaction with opioids.

They also help ensure affordability. For instance, some doctors accept money or gifts from drug and medical device companies who want the doctors to prescribe their drugs and use their products. These reviews make sure patients receive the most affordable, safest, and beneficial treatments, regardless of the doctor’s financial incentives.

HB649 would effectively end a health plan’s ability to conduct these reviews, thus undercutting safety and affordability.

The bill:

  • Dramatically increases insurance premiums. One study said the impact of passing a bill like HB649 could increase premiums by as much as $2,800 a year for a family of four.
  • Rewards doctors with a “Gold Card” even if they mess up 20 percent of the time. Under this bill, a doctor could over-prescribe opioids, expose you to huge bills by sending labs out-of-network, or have you pay for duplicative tests one out of every five times and keep their “Gold Card.” This “Gold Card” is essentially a free pass where doctors do not have to go through any cost or safety reviews.
  • Undermines new federal guidelines and institutes unworkable standards that will result in more denials from insurance companies.  

Everyone agrees that patients shouldn’t face unreasonable burdens and delays when it comes to getting treatment or medicine.

They should also have access to the safest and most affordable care possible.

New federal regulations address these burdens by requiring health insurers to make major changes to their prior authorization processes.

HB649 gets in the way of these new regulations.

And that will only mean bad things for cost, safety, and people’s healthcare experience.  

Help Our Champions Stand Strong

While the lobbyist and special interest were able to get both these bills through the House, they have not passed the Senate.

Many of our Affordable Healthcare Champions are standing strong against the cost-raising proposals.  

Help us have their back and sign up here to say NO to Higher Drug Cost and NO to Higher Premiums & Unsafe Care.

Your support can help keep these bad bills from becoming law.

Be sure to sign up for updates and be the first to know when lawmakers introduce bills that will impact what you pay at the doctor and pharmacy.

How to Take Action

Our Coalition is only as strong as our advocates. Grassroots support is how we effect change. Take Action for lower healthcare costs.

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