New year brings new NC laws on gender identity, prescription drugs and pensions

Several new North Carolina laws took effect with the new year on Thursday.

They include measures touching on sex and gender — echoing actions taken by President Donald Trump — changes aimed at reining in prescription drug costs, shifts in who makes investment decisions for the state’s pension plan, and more.

Missing is a new state budget for the fiscal year that began in July. Decisions on that, Medicaid funding and other major spending issues will carry over into next year.

Here’s a look at the new laws taking effect Thursday.

Control of North Carolina’s pension investments

House Bill 506: 2025 State Investment Modernization Act.

Under the recommendation of State Treasurer Brad Briner, who took office in January, lawmakers passed a bill that shifts who controls North Carolina pension investment decisions.

Instead of the treasurer alone holding final authority, the law created the North Carolina Investment Authority, an independent agency within the treasurer’s department, overseen by a five-member board that votes on investment decisions.

The board includes the treasurer, along with one appointee each from the House speaker, Senate president pro tempore, governor and treasurer. It appoints a chief investment officer, who oversees day-to-day investing.

Briner has said the change was needed because North Carolina ranked near the bottom nationally for pension plan returns. The state’s pension returns averaged 5.9% annually over the past decade, below the 7.5% national average, while states like Washington posted returns of about 11%, he said during an April committee hearing.

According to a November report, the nine-month return on the state’s $139 billion pension fund jumped to nearly 11%, with the fund growing by more than $5 billion in the last quarter alone.

Parts of the bill took effect when it became law in June. But on Thursday, the remaining sections of the bill took effect.

Regulating pharmacy access, drug pricing

Senate Bill 479: SCRIPT Act

This law looks to regulate the prescription drug market and pharmacy benefit managers — the middlemen who negotiate drug discounts with manufacturers and wholesalers on behalf of insurers.

The legislation aims to bar PBMs from steering patients to their own or preferred pharmacies, including mail-order services, and requires them to allow any willing pharmacy to join their networks. PBMs are often owned or are affiliated with mail-order or retail chains —for example, CVS Health owns the PBM CVS Caremark.

The bill mandates that most rebate savings be passed along to patients. It prohibits PBMs from paying their affiliated pharmacies more than others, and adds new reporting requirements. The bill regulates Pharmacy Services Administrative Organizations, which represent independent pharmacies in negotiations.

Many parts of SB 479 have already taken effect. Sections dealing with how price rebates pass through to patients, as well as requirements for drug manufacturers to notify interested parties of price increases, take effect Thursday.

Birth certificates for people adopted

Senate Bill 248: Birth Certificates for Persons Adopted.

This law allows adopted individuals, and some of their family members, to obtain certified copies or abstracts of a new birth certificate from the register of deeds in their county of birth, rather than only through the state registrar.

Surgical smoke, international doctors and workforce changes

House Bill 67: Healthcare Workforce Reforms.

This law spans more than 40 pages and addresses several health care issues. Provisions taking effect in January include measures that:

• Make North Carolina a member of the Interstate Medical Licensure Compact, making it easier for doctors from other states to practice in North Carolina and for North Carolina doctors to practice in other compact states.
• Create a new, limited licensing pathway for internationally trained doctors to practice in North Carolina.
• Require hospitals and ambulatory surgical facilities to use smoke evacuation systems during procedures likely to generate surgical smoke, a byproduct created by medical devices. The state’s Department of Health and Human Services may take action against violators.

Sex and gender definitions

House Bill 805, Prevent Sexual Exploitation/ Women and Minors, initially created protections for people whose explicit images appear on pornography websites without their consent. That version passed unanimously in both chambers. Later additions to the bill, however, prompted a divide, leading Democratic Gov. Josh Stein to veto the measure, The News & Observer previously reported.

“These mean-spirited bills would marginalize vulnerable people and also undermine the quality of public services and public education,” Stein said in a press release announcing his veto, The N&O reported.

Republican lawmakers overrode the veto in the GOP-led legislature, joined by one Democrat. House Speaker Destin Hall said it “would enshrine in law simple concepts that are just common sense.”

The section taking effect Thursday says that only two sexes exist and that gender identity will not be treated the same as sex under state law. The provision cites an executive order issued by Trump in January that says the federal government recognizes only two sexes — male and female. These provisions do not account for intersex people born with biological sex characteristics that do not fit typical definitions of male or female.

Other provisions bar state funding for gender transition procedures for inmates, increase parental control over school library materials, allow religious exemptions from school activities and restrict room-sharing by sex on school trips.

Other new state laws

• Sections taking effect in House Bill 926 prohibit local governments from setting road pavement design standards that are stricter than the state’s.
• Sections taking effect of House Bill 74 expand the categories of UNC System employees who may be classified as exempt from state minimum wage and overtime rules to include all temporary employees, at the discretion of the UNC Board of Governors.
• Sections taking effect of House Bill 40 deal with rules on how community property is handled at death in North Carolina.
• Sections taking effect of House Bill 388 include a provision allowing North Carolina attorneys to electronically store wills.
• Senate Bill 321 modify the educational and experience requirements for certification as a certified public accountant.
• Sections taking effect of House Bill 737 make various changes to insurance regulations.
• Sections taking effect of Senate Bill 690 create a new training pathway to become a certified residential real estate appraiser.

This story was originally published January 1, 2026 at 5:30 AM.

Luciana Perez Uribe Guinassi

The News & Observer

Luciana Perez Uribe Guinassi is a politics reporter for the News & Observer. She reports on health care, including mental health and Medicaid expansion, hurricane recovery efforts and lobbying. Luciana previously worked as a Roy W. Howard Fellow at Searchlight New Mexico, an investigative news organization.