Crossover Update: Where Healthcare Cost Bills Stand

Each legislative session, lawmakers self-impose a “crossover” deadline. This is the date by which a bill must pass either the State House or Senate to be considered in the remaining months of the legislative calendar.

This year, many bills that impact healthcare access and affordability have passed and are still alive for consideration.

Here is a rundown.

Senate Bills Passed

• Senate Bill 24: Government Mandates Increase Healthcare Costs – Senate Bill 24 would ensure that if any new mandates are passed, an equal number must also be repealed to help offset the cost. In addition, the bill protects taxpayers and the State Health Plan by ensuring that any new mandate also contains funding to pay for its added cost. Companion legislation, House Bill 46, has been introduced but not voted on.

• Senate Bill 316: Lower Healthcare Costs – Senate Bill 316 will save North Carolinians hundreds of millions of dollars in healthcare costs while making billing practices fairer and more transparent. The legislation eliminates hidden hospital facility fees charged at non-hospital settings. It ensures that patients can ask for, and receive, a good faith estimate of their healthcare costs prior to receiving care. It puts consumer protections in place around medical debt collections. And it ensures that patients are notified prior to a procedure if they are going to be cared for anyone outside of their insurance network.

• Senate Bill 315: Patient-Focused Prior Authorization Reforms – Through a legislative procedure, Senate Bill 315 was included in and passed with Senate Bill 316. The reforms in this bill would set fair turnaround times for prior authorization reviews, and it increases transparency for prior authorization processes and procedures through important disclosure requirements. The bill maintains continued patient safety and affordability.

• Senate Bill 479: SCRIPT Act – Senate Bill 479 enhances transparency into PSAOs, PBMs, and pharmaceutical manufacturer pricing. It supports independent pharmacies by allowing them to enter into unique contracts that suit their needs, by allowing them to decline to fill prescriptions when taking a loss, and by stopping PSAOs from requiring they purchase more expensive drugs from specific wholesalers. It will lower drug costs for consumers by requiring they receive prescription drug rebates at the point of sale.

• Senate Bill 370: CON Reform – Senate Bill 370 would repeal North Carolina’s outdated Certificate of Need (CON) laws. CON laws limit the number of medical facilities that can operate in any given area. For a new clinic to enter the market, it must petition the government and demonstrate a “need” for another facility of its type. This limits the kind of competition that can drive costs down and increase access to innovative care. Companion legislation, House Bill 455, has been introduced but not voted on.

• Senate Bill 335: Test & Treat Influenza and Strep – Senate Bill 335 allows for trained, licensed pharmacists test and treat patients for the flu and strep throat. Individuals often have greater access to pharmacies and visit them more frequently than doctor’s offices. Pharmacists can also provide these important services at reduced costs for their customers.

House Bills Passed

• House Bill 163: Pharmacy Tax & Higher Rx Costs – House Bill 163 would impose a new pharmacy tax on every prescription filled in North Carolina. The legislation increases dispensing fees by as much as 1000 percent, with no added benefit for the consumer. It prohibits paying pharmacies more who deliver on higher quality and better outcomes. And it imposes a government ban on a tool used by North Carolina businesses for price predictability on prescription drugs.

• House Bill 297: Government Imaging Mandate – House Bill 297 mandates that individuals and businesses, through their insurance premiums, pay for advanced diagnostic imaging tests such as MRIs and breast ultrasounds at the same $0 cost-share level as a preventive screening mammography. Patients should always get the care they need, and these screenings are already covered at standard insurance benefit levels. HB297 goes against medical recommendations from the United States Preventive Services Taskforce, the American Cancer Society, and the National Comprehensive Cancer Network. It could encourage overuse and misuse as tests such as MRIs and diagnostic breast ultrasounds are more expensive for patients – and more profitable for hospital systems.

• House Bill 156: Small Business Premium Increases – House Bill 156 would allow small businesses with just five employees to self-fund their health insurance. Premiums for North Carolina small businesses on the fully insured marketplace are increasing by as much as 19 percent in 2025 due, in part, to businesses moving off the marketplace for “alternative coverage” options such as those created by the legislature reducing small group size from 25 to 12 in 2024. The bill is unneeded as a legislative solution has already passed that gives companies with two or more employees access to self-funded insurance plans. Companion legislation, Senate Bill 218, has been introduced but not voted on.

• House Bill 434: Prior Authorization Changes – House Bill 434’s prior authorization reforms would have an overall negative impact for patient cost and safety. The legislation exempts providers from prior authorization if 80 percent of their claims are approved. North Carolinians should not be comfortable with only a four-out-of-five success rate from their providers. It fails to address the underlying problem that healthcare costs are too high, and it adds administrative requirements and restrictions that will put patients at risk for increased costs and safety gaps.

• House Bill 489: High-Cost Ambulance Mandate – House Bill 489 mandates that out-of-network ground ambulances be paid 400 percent of the current Medicare rate. The impact of a rate that is four-times greater than Medicare would mean patients with high-deductible plans receive significantly higher bills until they reach their deductibles, and everyone, regardless of their plan, would pay higher premiums to further cover this inflated cost. Costs for consumers would rise further as ambulance service providers go out-of-network to get the government-mandated 400 percent of Medicare reimbursement, as the rate would be substantially higher than current in-network rates.

• House Bill 567: Testing Mandate – House Bill 567 bill broadly defines biomarker testing and mandates that all tests are covered even if they are not needed or useful for the patient. Mandates such as these are both costly and unnecessary. Health plans routinely cover useful tests and update coverage when new evidence demonstrates a benefit. Covering unproven and potentially inaccurate tests can also lead to a cascade of other harmful, unnecessary, and costly procedures, treatments, and follow ups.

• House Bill 906: Prosthetic Mandate – It is important that individuals have access to prosthetic devices that meet their inclusive individual needs. As written, however, House Bill 906 would mandate individuals, through their premiums, pay for an unlimited number of devices at unlimited costs. The bill also fails to require that prosthetics be fitted by a reputable and licensed prosthetic professional or prohibit financial relationships between prosthetists and prosthetic companies even though there is evidence of fraud, waste, and abuse in this area.