State Codes and Statutes

State Codes and Statutes

Statutes > North-carolina > Chapter_135 > GS_135-45_11

§ 135‑45.11.  Cost‑savingsinitiatives and incentive programs authorized.

(a)        Cost‑SavingInitiatives. – Coverage of Over‑the‑Counter Medications. – TheExecutive Administrator and Board of Trustees may authorize coverage for over‑the‑countermedications as recommended by the Plan's pharmacy and therapeutics committee.In approving for coverage one or more over‑the‑counter medications,the Executive Administrator and Board of Trustees shall ensure that eachrecommended over‑the‑counter medication has been analyzed to ensuremedical effectiveness and Plan member safety. The analysis shall also addressthe financial impact on the Plan. The Executive Administrator and Board ofTrustees may impose a co‑payment to be paid by each covered individualfor each packaged over‑the‑counter medication. The ExecutiveAdministrator and Board of Trustees may adopt policies establishing limits onthe amount of coverage available for over‑the‑counter medicationsfor each covered individual over a 12‑month period. Prior to implementingpolicy and co‑payment changes authorized under this section, theExecutive Administrator and Board of Trustees shall submit the proposedpolicies and co‑payments to the Committee on Employee Hospital andMedical Benefits for its review.

(b)        Incentive Programs.– For the purposes of helping Plan members to achieve and maintain a healthylifestyle without impairing patient care, and to increase cost effectiveness inPlan coverage, the Executive Administrator and Board of Trustees may adoptprograms offering incentives to Plan members to encourage changes in memberbehavior or lifestyle designed to improve member health and promote cost‑efficiencyin the Plan. Participation in one or more incentive programs is voluntary onthe part of the Plan member. Before adopting an incentive program, theExecutive Administrator and Board of Trustees shall conduct an impact analysison the proposed incentive program to determine (i) whether the program islikely to result in significant member satisfaction, (ii) that it will notadversely affect quality of care, and (iii) whether it is likely to result insignificant cost savings to the Plan. The impact analysis may be conducted by acommittee of the Plan, in conjunction with the Plan's consulting actuary,provided that the Plan's medical director participates in the analysis. Anapproved incentive plan may provide for a waiver of deductibles, co‑payments,and coinsurance required under this Article in order to determine theeffectiveness of the incentive program in promoting the health of members andincreasing cost‑effectiveness to the Plan. The Executive Administratorand Board of Trustees shall, before implementing incentive programs authorizedunder this section, submit the proposed programs to the Committee on EmployeeHospital and Medical Benefits for review.  (2008‑168, s. 3(p).)