North Carolina requires health insurance and state health plans to cover early refills for prescription eye drops

Original title: Prescription Eye Drop Early Refill Coverage.

Last action · April 16, 2025: Re-ref Com On Appropriations (House action)Sponsors: Tim Reeder and 20 others

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Introduced

Committee

Floor Vote

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What This Bill Would Do

s and the in North Carolina are required to cover early refills for prescription eye drops when requested after 70% of the dosage has been used or 21 days have passed, provided the refill does not exceed the provider's authorized limit. The requirement takes effect October 1, 2025, for general health plans and at the start of the next plan year for the State Health Plan, backed by a $100,000 recurring annual to the Department of State Treasurer.

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.

Directly affected

insured individuals using prescription eye drops

Patients gain the right to insurance coverage for early eye drop refills after meeting specified usage or time thresholds.

Directly affected

health insurers in North Carolina

Insurers are prohibited from denying coverage for early eye drop refills when patients satisfy the statutory conditions.

Directly affected

Department of State Treasurer

The department receives a recurring $100,000 appropriation each year of the 2025-2027 fiscal biennium to support the State Health Plan mandate.

Key Facts

Health benefit plans offered by insurers in North Carolina that cover prescription eye drops must not deny coverage for early refills if specific usage or time conditions are met.
Patients may request an early refill for a 30-day supply after using 70% of the dosage units according to provider instructions.
Patients may also request an early refill 21 days after the original distribution date or the most recent refill distribution date.
The requested refill must not exceed the limit on the number of refills indicated by the prescribing health care provider.

Show all 8 facts

The State Health Plan is explicitly subjected to the same early refill coverage mandate under G.S. 135-48.51.
The general health plan requirement takes effect October 1, 2025, and applies to contracts issued, renewed, or amended on or after that date.
The State Health Plan requirement applies as of the start of the next plan year following October 1, 2025.
The act appropriates $100,000 in recurring funds from the General Fund to the Department of State Treasurer for each year of the 2025-2027 fiscal biennium to fund the State Health Plan mandate.

Frequently Asked Questions

Does this requirement apply to the State Health Plan for teachers and state employees?

Yes. The bill amends G.S. 135-48.51 to subject the to the same early refill mandate.

How much funding is appropriated to implement this requirement for state employees?

The bill appropriates $100,000 in recurring funds from the General Fund to the Department of State Treasurer for each year of the 2025-2027 fiscal biennium.

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Where This Stands

Currently in committee. The next step in the legislative lifecycle is Floor Vote.

Procedural history

5 actions

Apr 16, 2025House
Re-ref Com On Appropriations
Apr 16, 2025House
Reptd Fav
Apr 9, 2025House
Ref to the Com on Insurance, if favorable, Appropriations, if favorable, Finance, if favorable, Rules, Calendar, and Operations of the House
Apr 9, 2025House
Passed 1st Reading
Apr 8, 2025HouseIntroduced
Filed

Version history

Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.

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