Pharmacists/Collaborative Practice
Senate Bill 357 would modernize and expand North Carolina’s physician-pharmacist collaborative practice framework. It revises existing law governing clinical pharmacist practitioners so pharmacists working under approved collaborative practice agreements can perform a broader set of delegated health care services, including drug therapy management, modifying dosages and dosage forms, ordering tests, and, in certain settings, ordering medications and tests under facility policies. The bill also clarifies that collaborative practice agreements may be site-specific, may involve multiple providers, and may include authorization for certain drug substitutions, including same-class and biosimilar substitutions, with physician notification and documentation.
The bill also creates new insurance-related requirements. It would require health benefit plans to cover pharmacist-provided health care services when those services are within the pharmacist’s lawful scope of practice and would have been covered if performed by another provider. It further requires insurers to accept pharmacist credentialing delegated through contracted health care facilities, and it extends comparable coverage requirements to third-party administrators and pharmacy benefits managers. The bill is set to take effect October 1, 2025, with the insurance provisions applying to contracts entered into, renewed, or amended on or after that date.
S357 would amend multiple sections of Chapters 90 and 58 of the North Carolina General Statutes. In Chapter 90, it broadens the statutory definition and authority of clinical pharmacist practitioners and updates the rules for collaborative practice agreements between physicians and pharmacists. In Chapter 58, it imposes new coverage and credentialing obligations on insurers, third-party administrators, and pharmacy benefits managers, potentially affecting health benefit plan administration, provider network participation, and reimbursement for pharmacist-delivered services.
The available voting history suggests strong support for the bill, as it passed second reading in the Senate 46-0. No committee transcripts were provided, so there is no recorded debate to indicate organized opposition or detailed concerns in the available materials. Overall, the bill appears to have been received favorably as a health care practice and access measure.
The main areas where contention could arise are the scope of pharmacist authority and the insurance mandates. The bill expands pharmacists’ ability to modify therapy, order tests, and participate in collaborative practice agreements, which may raise concerns for some physicians or regulators about supervision, patient safety, and the boundaries of professional practice. On the insurance side, insurers, third-party administrators, and pharmacy benefits managers may object to the new coverage and credentialing requirements because they could increase administrative burdens, narrow plan flexibility, or affect costs. No specific objections are documented in the provided record, however.