Prescription Eye Drop Early Refill Coverage.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 820

Short Title: Prescription Eye Drop Early Refill Coverage. (Public)
Sponsors: Representatives Reeder, Campbell, Rhyne, and Crawford (Primary Sponsors).
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
Referred to: Insurance, if favorable, Appropriations, if favorable, Finance, if favorable, Rules,
Calendar, and Operations of the House
April 9, 2025
*H820-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO REQUIRE HE ALTH BENEFIT PLANS T HAT PROVIDE COVERAGE FOR 2
PRESCRIPTION EYE DRO PS TO ALSO PROVIDE C OVERAGE FOR EARLY 3
REFILLS. 4
The General Assembly of North Carolina enacts: 5
SECTION 1.(a) Article 3 of Chapter 58 of the General Statutes is amended by adding 6
a new section to read: 7
"§ 58-3-266. Coverage for early refills of prescription eye drops. 8
Every health benefit plan offered by an insurer in this State that provides coverage for 9
prescription eye drops shall not deny coverage for a refill of an eye drop prescription if both of 10
the following conditions apply: 11
(1) For a 30 -day supply, the patient requested the refill after either of the 12
following: 13
a. The passage of an amount of time after which a patient should have 14
used seventy percent (70%) of the dosage units of the drug according 15
to a health care provider's instructions. 16
b. Twenty-one days after either (i) the original date the prescription was 17
distributed to the insured or (ii) the da te the most recent refill was 18
distributed to the insured. 19
(2) The refill requested by the insured would not exceed the limit, if any, on the 20
number of refills for that prescription that the prescribing health care provider 21
indicated on the original prescription." 22
SECTION 1.(b) G.S. 135-48.51 reads as rewritten: 23
"§ 135-48.51. Coverage and operational mandates related to Chapter 58 of the General 24
Statutes. 25
The following provisions of Chapter 58 of the General Statutes apply to the State Health Plan: 26
… 27
(9a) G.S. 58-3-266, Coverage for early refills of prescription eye drops. 28
…." 29
SECTION 1.(c) Subsection (a) of this section becomes effective October 1, 2025, 30
and applies to contracts issued, renewed, or amended on or after that date. Subsection (b) of this 31
section applies as of the start of the next plan year following that date. 32
SECTION 2. Effective July 1, 2025, there is appropriated from the General Fund to 33
the Department of State Treasurer the sum of one hundred thousand dollars ($100,000) in 34
General Assembly Of North Carolina Session 2025
Page 2 House Bill 820-First Edition
recurring funds for each year of the 2025-2027 fiscal biennium to be used to provide the coverage 1
required under Section 1(b) of this act. 2
SECTION 3. Except as otherwise provided, this act is effective when it becomes 3
law. 4