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Read. Follow. Verify.North Carolina HB 824 expands health plan coverage for pharmacist services and opioid overdose medications
Last action · April 17, 2025: Serial Referral To Finance Stricken (House action)Sponsors: Donna White and 12 others
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What This Bill Would Do
North Carolina House Bill 824 requires health benefit plans and third-party administrators to cover healthcare services provided by licensed pharmacists, mandates coverage for all FDA-approved prescription drugs for opioid use disorder and overdose without , and updates mental health parity statutes effective October 1, 2025.
Patients gain direct insurance coverage for pharmacist-provided clinical services and guaranteed access to specific opioid addiction medications without prior administrative approvals, while insurers and pharmacy benefit managers must adjust their reimbursement formulas to use NADAC or WAC pricing.
- House Bill 824 was introduced in the North Carolina General Assembly during the 2025 session to address opioid treatment access and align state insurance statutes with federal mental health parity standards. context
- The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 is a federal law preventing group health plans and health insurance issuers from imposing less favorable benefit limitations on mental health or substance use disorder benefits than on medical or surgical benefits. context
Who It Would Affect
Groups the bill's text would affect if enacted, as described in the record. Being affected is not a position for or against it.
Pharmacists
Pharmacists are authorized to have their clinical healthcare services covered by health benefit plans when acting within their scope of practice.
Insurers
Insurers must update health benefit plans to cover pharmacist services, accept facility credentialing, cover specific opioid drugs without prior authorization, and adjust pharmacy reimbursement formulas.
Pharmacies
Pharmacies are guaranteed specific reimbursement rates using NADAC or WAC plus a dispensing fee for dispensing required opioid treatment drugs.
Third-party administrators
Third-party administrators and pharmacy benefits managers must comply with the same prescription drug and pharmacy service coverage requirements as insurers.
Key Facts
- Insurers offering health benefit plans must cover healthcare services provided by a pharmacist if performed within their lawful scope of practice and if the plan would cover the service when performed by another healthcare provider.
- Insurers that delegate credentialing agreements to a contracted healthcare facility must accept that credentialing for all pharmacists employed by or contracted with those facilities.
- Insurers must provide coverage for all FDA-approved prescription drugs for the treatment of opioid disorder and opioid overdose, including placing them on closed formularies if maintained.
- Prescription drugs required for opioid disorder and overdose are exempt from prior authorization as a condition of coverage.
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- Pharmacies dispensing required opioid disorder and overdose drugs must be reimbursed at the most recent National Average Drug Acquisition Cost (NADAC) price plus a dispensing fee, or Wholesale Acquisition Cost (WAC) if NADAC is unavailable.
- Third-party administrators and pharmacy benefits managers are subject to the same prescription drug and pharmacy service coverage requirements as insurers.
- Mental illness health benefits coverage definitions and provisions are updated, replacing references to chemical dependency with substance use disorder across various statutes.
- Provisions relating to pharmacist services, credentialing, and opioid drug coverage become effective October 1, 2025, applying to insurance contracts issued, amended, or renewed on or after that date.
Frequently Asked Questions
Will health insurance cover healthcare services provided by a pharmacist under this bill?
Can insurers require prior authorization for opioid overdose and substance use disorder medications?
How will pharmacies be reimbursed for dispensing required opioid medications?
What else do you want to know?
News Coverage
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Votes, people, money & the original sourceWhere This Stands
Currently in committee. The next step in the legislative lifecycle is Floor Vote.
Procedural history
4 actions- Apr 17, 2025HouseSerial Referral To Finance Stricken
- Apr 9, 2025HouseRef to the Com on Insurance, if favorable, Finance, if favorable, Rules, Calendar, and Operations of the House
- Apr 9, 2025HousePassed 1st Reading
- Apr 8, 2025HouseIntroducedFiled
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →Lobbying Activity
No state lobbying filings in our records match this bill. Federal lobbying reports (LDA) cover Congress, so they are not listed on state bills.
Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Sponsors
Show 8 more sponsors
Discoveries
Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.
Integration of Pharmacist Clinical Services into Standard Health Plans
The legislation formally bridges pharmacist-delivered care (such as testing, assessment, and long-term injection administration) with standard medical and drug benefit network coverage requirements.
Connected Entities
Sources
www.ncleg.gov
Analysis Score
0–100- Significance80How much this matters to a regular citizen
- Controversy35Intensity of disagreement among stakeholders
- Entertainment5Compellingness for a non-policy-wonk reader
- Buzz40Current news / social attention level
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