{"data":{"id":"us-nc/n.c.-gen.-stat.-58-56b-35","jurisdiction":"us-nc","citation":"N.C. Gen. Stat. § 58-56B-35","heading":"(Effective October 1, 2026) Appeals.","body":"(a)\tDisputes. - If there is a dispute between an independent pharmacy and a PBM or third-party payer, then a PSAO which has entered into a PSAO-pharmacy contract with that independent pharmacy shall ensure and facilitate timely communication between the pharmacy and the PBM or third-party payer.\n(b)\tPSAO Contracted with an Independent Pharmacy. - If a third-party payer or a PBM provides any notice or other information to a PSAO that is related to an independent pharmacy with which the PSAO has entered into a PSAO-pharmacy contract, then that shall be considered provision of that notice or other information to the pharmacy with which the PSAO is contracted. A third-party payer or PBM shall not be required to provide notice or other information to both the PSAO and the independent pharmacy with which the PSAO has entered into a PSAO-pharmacy contract.\n(c)\tTimeliness. - A PSAO shall forward all notices of appeals from an independent pharmacy with which the PSAO has entered into a PSAO-pharmacy contract to the relevant PBM or third-party payer in a timely manner.\n(d)\tDenials. - If an appeal received by a PSAO from an independent pharmacy does not meet the minimum requirements contained within a PSAO-pharmacy contract, then the PSAO shall notify the pharmacy and provide the denial reason or reasons. The PSAO shall allow the pharmacy to resubmit the appeal for review by a PBM, if applicable. (2025-69, s. 2.1.)","path":["Chapter 58. Insurance.","Article 56B. Pharmacy Services Administrative Organizations."],"source_url":"https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_58/GS_58-56B-35.html","current_through":"S.L. 2026-30","vintage":"","retrieved_at":"2026-08-27T18:06:53Z","sha256":"c8bcab3c798967d8d73112d5aa9274209eb951db90990dbdf808dce9494f6b26","source_id":"us-nc","stale":false,"prev":"us-nc/n.c.-gen.-stat.-58-56b-30","next":"us-nc/n.c.-gen.-stat.-58-56b-40"},"notice":"GroundRules: Original legal text. Not legal advice."}