North Carolina General Statutes Chapter 58. Insurance § 58-3-241. Healthcare services provided by pharmacists

Current as of January 01, 2023 | Updated by Findlaw Staff

(a) The following definitions apply in this section:

(1) Healthcare provider.--Either of the following:

a. An individual who is licensed, certified, or otherwise authorized under Chapter 90 of the General Statutes to provide healthcare services in the ordinary course of business or practice of a profession or in an approved education or training program.

b. A health care facility licensed under Chapter 131E or Chapter 122C of the General Statutes and where healthcare services are provided to patients.

(2) Healthcare services.--Any of the following health or medical procedures or services rendered by a healthcare provider:

a. Testing, diagnosis, or treatment of a health condition, illness, injury, or disease. This includes testing, diagnosis, or treatment rendered by a pharmacist acting within the pharmacist's scope of practice.

b. Dispensing of drugs, medical devices, medical appliances, or medical goods for the treatment of a health condition, illness, injury, or disease.

c. Administration of a vaccine or medication.

(3) Pharmacist.--An individual licensed to practice pharmacy under Article 4A of Chapter 90 of the General Statutes or the relevant laws of another state.

(b) A health benefit plan offered by an insurer in this State shall cover healthcare services provided by a pharmacist if all of the following conditions are met:

(1) The service or procedure was performed within the pharmacist's licensed lawful scope of practice.

(2) The health benefit plan would have covered the service if the service or procedure had been performed by another healthcare provider.

(c) The participation of a pharmacy in a drug benefit provider network of a health benefit plan shall not satisfy any requirement that insurers offering health benefit plans include pharmacists in medical benefit provider networks.

(d) An insurer shall accept a claim under this section regardless of whether it is submitted by a pharmacist or a pharmacy submitting the claim on behalf of a pharmacist the pharmacy employs or contracts with.

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Cite this article: FindLaw.com - North Carolina General Statutes Chapter 58. Insurance § 58-3-241. Healthcare services provided by pharmacists - last updated January 01, 2023 | https://codes.findlaw.com/nc/chapter-58-insurance/nc-gen-st-sect-58-3-241/

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