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SB 414

Pharmacists/Test and Treat.

2025-2026 Session Introduced by Gale Adcock and 5 co-sponsors

Pharmacists can order CLIA‑waived tests and treat certain conditions per statewide protocols, expanding point‑of‑care testing and treatment within pharmacist scope.

Passed 1st Reading
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Bill Summary · SB 414

SB 414 — “Pharmacists / Test and Treat” (North Carolina) — Summary

Status: Passed first reading (Introduced Feb 14, 2025)
Primary sponsors: Senators Jones, Ford, Moffitt (NC)
Effective dates: Key provisions effective Oct 1, 2025; other provisions effective on enactment unless otherwise stated.

Purpose

Authorize pharmacists to order and perform CLIA‑waived diagnostic tests and to treat certain conditions identified by those tests under statewide protocols, and require fair insurance coverage/reimbursement when pharmacists provide covered health services within their licensed scope. The bill is also intended to improve access to basic testing and treatment (for example, in rural areas) and to align insurer and benefits‑administrator practices with pharmacist‑delivered care.

Key provisions

  • Definitions

    • Adds/clarifies terms including “CLIA‑waived test” and “clinical pharmacist practitioner.”

  • Pharmacist scope: testing and treatment

    • Authorizes a pharmacist to order and perform CLIA‑waived tests (tests approved by FDA and designated CLIA‑waived).
    • Permits pharmacists to use CLIA‑waived test results to:
    • Assist clinical decisions related to medication use/monitoring; and
    • Treat influenza, COVID‑19, group A streptococcal pharyngitis, and other conditions screened by CLIA‑waived tests — but only in accordance with statewide protocols to be developed.
    • Explicit prohibition: a pharmacist may not treat a condition under this authority with any controlled substance classified in Schedules I–IV.

  • Statewide protocols

    • The State Health Director, in consultation with the NC Board of Pharmacy and NC Medical Board, must develop statewide protocols, including patient parameters that require referral to primary, urgent, or emergency care.

  • Insurance and reimbursement changes (Chapter 58 additions)

    • Health benefit plans must cover healthcare services provided by a pharmacist if:
    • The service was performed within the pharmacist’s lawful scope of practice; and
    • The plan would have covered the same service if provided by another healthcare provider.
    • Participation of a pharmacy in a drug benefit network does not satisfy any requirement to include pharmacists in medical provider networks (i.e., pharmacists can be considered medical providers for these services).
    • If insurers delegate pharmacist credentialing to a contracted healthcare facility, the insurer must accept that credentialing for pharmacists employed/contracted by that facility.
    • Extends applicable prescription drug/pharmacy‑service coverage requirements to third‑party administrators and to pharmacy benefits managers (PBMs).

Who is affected

  • Pharmacists and pharmacies (new testing/treatment authorities; potential new clinical workflows and credentialing requirements)
  • Patients — increased access to point‑of‑care testing and treatment
  • Insurers, PBMs, and third‑party administrators — new coverage, credentialing, and network implications
  • NC State Health Director, Board of Pharmacy, NC Medical Board — responsible for protocol development and implementation

Timeline / implementation

  • Pharmacist testing/treatment authority and insurance provisions are effective Oct 1, 2025 (applies to contracts entered/renewed on/after that date where specified).
  • The State Health Director must promulgate statewide protocols (timeline not specified in the bill text; consultation with boards required).

Potential impacts and considerations

  • Access: Likely to expand timely access to testing and low‑acuity treatment (notably in underserved/rural areas).
  • Cost and utilization: Could shift some outpatient testing/treatment from clinics/EDs to pharmacies; insurer cost impacts are uncertain and depend on reimbursement rules and utilization.
  • Clinical safeguards: Protocols and the prohibition on controlled substance treatment are intended to limit risks; referral thresholds will be important.
  • Administrative/contracting changes: Insurers, PBMs, and third‑party administrators will need to adjust credentialing, network, and benefit administration practices.

For implementation details (exact protocol content, reimbursement rates, and administrative rules), watch for guidance issued by the State Health Director and follow‑on rulemaking or insurer policy updates.

Compiled from official sources — confirm details with the bill’s official record.

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