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Insurance Commissioner Causey, AG Jackson pen joint message to NC’s PBMs
Plain English Summary
North Carolina's Insurance Commissioner Mike Causey and Attorney General Jeff Jackson have announced new rules for Pharmacy Benefits Managers (PBMs) in the state. The SCRIPT Act, which became law in 2025, gives the North Carolina Department of Insurance more authority to regulate PBMs and investigate any unfair practices. This law aims to make PBMs more transparent and ensure better protections for consumers and pharmacies.
PBMs must now allow any pharmacy to join their networks and cannot force consumers to buy medications only from mail-order pharmacies. Additionally, they must ensure that reimbursement rates for independent pharmacies cover the costs of the drugs they provide. Insurance agents should stay informed about these changes and ensure their clients understand their rights under the new law.
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RALEIGH
Feb 17, 2026
North Carolina Insurance Commissioner Mike Causey and Attorney General Jeff Jackson have co-authored a letter to the state’s Pharmacy Benefits Managers (PBMs) informing them of the new SCRIPT Act.
The SCRIPT Act, passed into law by the General Assembly in 2025, bolsters and expands the legal and regulatory framework and enforcement authority of the N.C. Department of Insurance over PBMs. The Act also strengthens the Department of Justice’s ability to investigate PBMs and, if appropriate, pursue legal action against deceptive or anti-competitive PBM practices.
A PBM is an entity who contracts with a pharmacy on behalf of an insurer or third-party administrator to administer or manage prescription drug benefits. This includes negotiating rebates with manufacturers for drugs, processing claims for prescription drugs or medical supplies or providing retail network management for pharmacies or pharmacists, and paying pharmacies or pharmacists for prescription drugs or medical supplies.
“The NCDOI and NCDOJ are focused on promoting a robust, transparent and stable insurance market while also ensuring the safety and fair treatment of North Carolin consumers,” Commissioner Causey and Attorney General Jackson say in their letter. “North Carolina’s SCRIPT Act represents a shift toward PBM transparency, accountability and consumer protections.
Commissioner Causey and Attorney General Jackson conclude: “The NCDOI and NCDOJ will uphold the legislative mandate of the General Assembly and, where warranted, will pursue all available remedies under law.”
The letter reminds PBMs of certain consumer and pharmacy protections in the SCRIPT Act:
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PBMs must allow any willing pharmacy to participate in their networks.
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PBMs cannot require that a consumer purchase prescription drugs exclusively through a mail-order pharmacy.
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Reimbursement rates for an independent pharmacy or a pharmacy in a pharmacy desert must at least cover the acquisition cost for the covered drug, device or service.
North Carolina currently has 23 licensed PBMs, with four more licenses pending.
Click here to view the letter to PBMs.
Related Topics:
NCDOI
NC Department of Insurance Press Release