North Carolina

Quick Facts

Key Provisions

• A DPC arrangement must be established through a written contract, known as a "direct primary care agreement," signed by both the provider and the patient.
• The law explicitly states that a DPC agreement is not insurance and is not subject to the state's insurance code (Title 58). Agreements must include a disclosure informing the patient of this fact.
• Eligible providers include licensed physicians (MD/DO), physician assistants (PAs) practicing under physician supervision, and nurse practitioners (NPs) practicing within their authorized scope.
• Providers are limited to offering "primary care services," which includes routine health assessments, management of chronic conditions, and treatment for acute illnesses and injuries.
• The agreement must detail the specific primary care services covered, the periodic fee amount, and the payment schedule. While there are no fee caps, providers must give patients 60 days' notice before making any changes to the fee.
• Providers operating under a DPC agreement are prohibited from billing third-party payers, such as insurance companies, on a fee-for-service basis for any services covered by the agreement.
• Patients have the right to terminate their agreement at any time with written notice. Providers may terminate with 30 days' written notice, or immediately for specific causes like non-payment.
• If an agreement is terminated by either party, the provider is legally required to refund the unused portion of any prepaid fees to the patient on a prorated basis.
• The statute imposes a patient panel limit, stating that a primary care provider may not enter into more than 300 direct primary care agreements at any given time.
• Providers must ensure 24-hour telephone access for their patients, either directly or through another designated healthcare professional who has access to the patient's medical records.

Medication Dispensing

In North Carolina, DPC practices must adhere to the state's general regulations for in-office medication dispensing, as there are no DPC-specific exemptions. Under the NC Pharmacy Practice Act (N.C. Gen. Stat. § 90-85.15B) and rules from the North Carolina Board of Pharmacy, licensed physicians, PAs, and NPs may dispense medications directly to their patients if they are registered with the Board as a "dispensing practitioner." This authority is typically used for providing pre-packaged medications, starter doses, or limited supplies for patient convenience. It does not permit a DPC clinic to operate as a full-service pharmacy; large-scale dispensing requires separate and full pharmacy licensure.

Medicaid Provisions

As of now, North Carolina has not established any specific provisions, pilot programs, or waivers to integrate the Direct Primary Care model with its Medicaid program or the State Employee Health Plan. State-run initiatives like NC Medicaid Direct and the Healthy Opportunities Pilots focus on other healthcare delivery and social determinant goals and do not currently include pathways for Medicaid beneficiaries to use their benefits for DPC membership fees. Therefore, DPC services in North Carolina are typically paid for directly by individuals or employers, separate from any state-funded health coverage.