23 CAR § 152-102. Third party requirements

A third party shall: (1) Inform a patient that the patient is not required to use a mail-order pharmacy; (2) Obtain a signed waiver from a patient before allowing the use of a mail-order pharmacy; (3) Make drug formulary and coverage decisions based on the third party's normal course of business; (4) Allow a patient the freedom to use any pharmacy or any provider the patient chooses, whether or not the pharmacy participates in 340B drug pricing; and (5) Eliminate discriminatory contracting as it relates to: (A) Transferring the benefit of 340B drug-pricing savings from one (1) entity, including critical access hospitals, federally qualified health centers, other hospitals, or 340B drug-pricing participants and their underserved patients, to another entity, including without limitation: (i) Pharmacy benefits managers; (ii) Private insurers; and (iii) Managed care organizations; (B) Pricing that occurs when offering a lower reimbursement for a drug purchased under 340B drug pricing than for the same drug not purchased under 340B drug pricing; (C) Refusal to cover drugs purchased under 340B drug pricing; (D) Refusal to allow 340B drug-pricing pharmacies to participate in networks; and (E) Charging more than fair market value or seeking profit sharing in exchange for services involving 340B drug pricing.