N.C. Gen. Stat. § 58-3-182 (2026)

(a) Definitions. - The following definitions apply in this section:

(1) Defined cost-sharing. - A deductible payment or coinsurance amount imposed on an insured for a prescription drug that is covered under the insured's health benefit plan.

(2) Reserved for future codification purposes.

(3) Reserved for future codification purposes.

(4) Rebate. - A formulary discount or price concession attributable to the utilization of prescription drugs in the State and that is paid by a manufacturer to a pharmacy benefits manager.

(b) When calculating an insured's defined cost-sharing for a covered prescription drug at the point of sale, an insurer offering a health benefit plan shall base the calculation on the price of the prescription drug after taking into account all rebates associated with that prescription drug. The price of the prescription drug shall be reduced by an amount equal to ninety percent (90%) of all rebates received, or to be received, in conjunction with the dispensing or administration of the prescription drug.

(c) Nothing in this section shall preclude an insurer from decreasing an insured's defined cost-sharing by an amount greater than that required under this section.

(d) By January 1 of each year, each insurer offering a health benefit plan shall submit to the Commissioner a certification attesting that, for all health benefit plans offered in this State by the insurer, the insurer has complied with the requirements of this section. The Commissioner shall establish the form to be utilized for this certification.

(e) Failure to complete the certification or comply with any of the other requirements under this section is a violation subject to G.S. 58-2-70. Each day that an insurer fails to complete the certification is considered a separate violation.

(f) A violation of this section is an unfair trade practice under Article 63 of this Chapter and under G.S. 75-1.1 and is subject to all of the enforcement and penalty provisions of an unfair trade practice under this Chapter and under Article 1 of Chapter 75 of the General Statutes.  (2025-69, s. 7.1.)

§ 58-3-185.  Lien created for payment of past-due child support obligations.

(a) In the event that the Department of Health and Human Services or any other obligee, as defined in G.S. 110-129, provides written notification to an insurance company authorized to issue policies of insurance pursuant to this Chapter that a claimant or beneficiary under a contract of insurance owes past-due child support and accompanies this information with a certified copy of the court order ordering support together with proof that the claimant or beneficiary is past due in meeting this obligation, there is created a lien upon any insurance proceeds in favor of the Department or obligee. This section shall apply only in those instances in which there is a nonrecurring payment of a lump-sum amount equal to or in excess of three thousand dollars ($3,000) or periodic payments with an aggregate amount that equals or exceeds three thousand dollars ($3,000).

(b) Liens arising under this section shall be subordinate to liens upon insurance proceeds for personal injuries arising under Article 9 of Chapter 44 of the General Statutes and valid health care provider claims covered by health benefit plans as defined in G.S. 58-3-172. As used in this section, the term health benefit plans does not include disability income insurance. (1995, c. 538, s. 6(a); 1995 (Reg. Sess., 1996), c. 674, ss. 1, 2; 1997-443, s. 11A.118(a).)