{"data":{"id":"us-nc/n.c.-gen.-stat.-58-51-37.1","jurisdiction":"us-nc","citation":"N.C. Gen. Stat. § 58-51-37.1","heading":"Lock-in program for certain controlled substances.","body":"(a)\tAs used in this section, \"covered substances\" means any controlled substance identified as an opioid or benzodiazepine, excluding benzodiazepine sedative-hypnotics, contained in Article 5 of Chapter 90 of the General Statutes, unless one of the following conditions are met:\n(1)\tIf the Department of Health and Human Services specifically identifies the opioid or benzodiazepine as a substance excluded from coverage by the Medicaid Beneficiary Management Lock-In Program described in its Outpatient Pharmacy Clinical Coverage Policy adopted in accordance with G.S. 108A-54.2, then the opioid or benzodiazepine is not a covered substance under this section.\n(2)\tIf the Department of Health and Human Services specifically identifies a controlled substance contained in Article 5 of Chapter 90 of the General Statutes other than an opioid or benzodiazepine as a controlled substance covered by the Medicaid Beneficiary Management Lock-In Program described in its Outpatient Pharmacy Clinical Coverage Policy adopted in accordance with G.S. 108A-54.2, then the controlled substance is a covered substance under this section.\n(b)\tAs used in this section, \"lock-in program\" means a requirement that an insured select a single prescriber and a single pharmacy for obtaining covered substances under a health benefit plan.\n(c)\tAn insurer may develop a lock-in program as part of a health benefit plan for insureds who meet any of the following criteria:\n(1)\tHave filled six or more prescriptions for covered substances in a period of two consecutive months.\n(2)\tHave received prescriptions for covered substances from three or more health care providers in a period of two consecutive months.\n(3)\tAre recommended to the insurer as a candidate for the lock-in program by a health care provider.\n(d)\tA lock-in program developed pursuant to subsection (c) of this section shall comply with all of the following:\n(1)\tAn insured shall not be subject to the lock-in program until the insurer has notified the insured in writing that the insured will be subject to the lock-in program.\n(2)\tAn insured subject to the lock-in program shall be given the opportunity to select a single prescriber and a single pharmacy from a list of prescribers and pharmacies participating in the health benefit plan provider network. For any insured who fails to select a single prescriber, the insurer shall use algorithmic guidelines to assign the insured a single prescriber from a list of prescribers participating in the health benefit plan provider network. For any insured who fails to select a single pharmacy, the insurer shall use algorithmic guidelines to assign the insured a single pharmacy from a list of pharmacies participating in the health benefit plan provider network.\n(3)\tAn insured shall not be required to use the single prescriber or single pharmacy selected for the lock-in program to obtain prescriptions drugs covered by the health benefit plan that are not covered substances. An insured who is subject to a lock-in program retains all rights under G.S. 58-51-37 to obtain prescription drugs covered by a health benefit plan that are not covered substances.\n(e)\tAn insurer's use of a lock-in program developed pursuant to subsection (c) of this section is not a violation under G.S. 58-51-37. (2018-49, s. 3(b).)","path":["Chapter 58. Insurance.","Article 51. Nature of Policies."],"source_url":"https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_58/GS_58-51-37.1.html","current_through":"S.L. 2026-30","vintage":"","retrieved_at":"2026-08-27T18:06:53Z","sha256":"9ec5a19939ff1f3a258afbe444d1d5e68b191f50c80232ee55f2d3b6fd2c198d","source_id":"us-nc","stale":false,"prev":"us-nc/n.c.-gen.-stat.-58-51-37","next":"us-nc/n.c.-gen.-stat.-58-51-38"},"notice":"GroundRules: Original legal text. Not legal advice."}