AN ACT to require health benefit plans that provide coverage for prescription eye drops to also provide coverage for Early refills.

The General Assembly of North Carolina enacts:

SECTION 1.(a)  Article 3 of Chapter 58 of the General Statutes is amended by adding a new section to read:

§ 58‑3‑266.  Coverage for early refills of prescription eye drops.

Every health benefit plan offered by an insurer in this State that provides coverage for prescription eye drops shall not deny coverage for a refill of an eye drop prescription if both of the following conditions apply:

(1)        For a 30‑day supply, the patient requested the refill after either of the following:

a.         The passage of an amount of time after which a patient should have used seventy percent (70%) of the dosage units of the drug according to a health care provider's instructions.

b.         Twenty‑one days after either (i) the original date the prescription was distributed to the insured or (ii) the date the most recent refill was distributed to the insured.

(2)        The refill requested by the insured would not exceed the limit, if any, on the number of refills for that prescription that the prescribing health care provider indicated on the original prescription.

SECTION 1.(b)  G.S. 135‑48.51 reads as rewritten:

§ 135‑48.51.  Coverage and operational mandates related to Chapter 58 of the General Statutes.

The following provisions of Chapter 58 of the General Statutes apply to the State Health Plan:

…

(9a)      G.S. 58‑3‑266, Coverage for early refills of prescription eye drops.

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SECTION 1.(c)  Subsection (a) of this section becomes effective October 1, 2025, and applies to contracts issued, renewed, or amended on or after that date. Subsection (b) of this section applies as of the start of the next plan year following that date.

SECTION 2.  Effective July 1, 2025, there is appropriated from the General Fund to the Department of State Treasurer the sum of one hundred thousand dollars ($100,000) in recurring funds for each year of the 2025‑2027 fiscal biennium to be used to provide the coverage required under Section 1(b) of this act.

SECTION 3.  Except as otherwise provided, this act is effective when it becomes law.