Bill Summary – FastDemocracy

0532.01000
     Sixty-eighth
     Legislative Assembly                     SENATE BILL NO. 2140
     of North Dakota
     Introduced by
       Senators Mathern, Dever
       Representatives Hanson, McLeod, Pyle, Schauer
  A BILL for an Act to create and enact section 26.1-36-09.16 of the North Dakota Century Code,
  relating to accident and health insurance coverage of diabetes drugs and supplies; to amend
  and reenact section 26.1-36.6-03 of the North Dakota Century Code, relating to public
  employees self-insurance health plans; to provide for application; to provide an effective date;
  and to declare an emergency.
  BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
      SECTION 1. Section 26.1-36-09.16 of the North Dakota Century Code is created and
  enacted as follows:
      26.1-36-09.16. Insulin drug and supply cost-sharing limitations and formulary
 limitations.
     1.   As used in this section:
          a.     "Insulin drug" means a prescription drug that contains insulin and is used to treat
                 a form of diabetes mellitus. The term does not include an insulin pump, an
                 electronic insulin-administering smart pen, or a continuous glucose monitor, or
                 supplies needed specifically for the use of such electronic devices. The term
                 includes insulin in the following categories:
                 (1)   Rapid-acting insulin;
                 (2)   Short-acting insulin;
                 (3)   Intermediate-acting insulin;
                 (4)   Long-acting insulin;
                 (5)   Premixed insulin product;
                 (6)   Premixed insulin/GLP-1 RA product; and
                 (7)   Concentrated human regular insulin.
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           b.   "Medical supplies for insulin dosing and administration" means supplies needed
                for proper insulin dosing, as well as supplies needed to detect or address medical
                emergencies in an individual using insulin to manage diabetes mellitus. The term
                does not include an insulin pump, an electronic insulin-administering smart pen,
                or a continuous glucose monitor, or supplies needed specifically for the use of
                such electronic devices. The term includes:
                (1)   Blood glucose meters;
                (2)   Blood glucose test strips;
                (3)   Lancing devices and lancets;
               (4)   Ketone testing supplies, such as urine strips, blood ketone meters, and
                     blood ketone strips;
               (5)   Glucagon, injectable or nasal forms;
               (6)   Insulin pen needles; and
               (7)   Insulin syringes.
          c.   "Pharmacy or distributor" means a pharmacy or medical supply company, or
               other medication or medical supply distributor filling a covered individual's
               prescriptions.
          d.   "Policy" means an accident and health insurance policy, contract, or evidence of
               coverage on a group, individual, blanket, franchise, or association basis.
     2.   An insurer may not deliver, issue, execute, or renew a policy that provides coverage
          for an insulin drug or medical supplies for insulin dosing and administration unless the
          policy complies with this section.
     3.   The policy must provide cost-sharing for a thirty-day supply of:
          a.   Prescribed insulin drugs which may not exceed twenty-five dollars per pharmacy
               or distributor, regardless of the quantity or type of insulin drug used to fill the
               covered individual's prescription needs.
          b.   Prescribed medical supplies for insulin dosing and administration, the total of
               which may not exceed twenty-five dollars per pharmacy or distributor, regardless
               of the quantity or manufacturer of supplies used to fill the covered individual's
               prescription needs.
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      4.   A policy may not allow a pharmacy benefits manager or the pharmacy or distributor to
           charge, require the pharmacy or distributor to collect, or require a covered individual to
           make, a cost-sharing payment for a covered insulin drug or medical supplies for insulin
           dosing and administration in an amount that exceeds the amount of the cost-sharing
           payment for the prescribed insulin drugs or prescribed medical supplies for insulin
           dosing and administration under subsection 3.
      5.   A policy may not allow for the use of a formulary to determine coverage of an insulin
           drug or medical supplies for insulin dosing and administration.
      6.   Subsection 3 does not require a policy to implement cost-sharing and does not
          prevent the implementation of cost-sharing in an amount less than the amount
          specified under subsection 3. Subsection 3 does not limit cost-sharing on an insulin
          pump, an electronic insulin-administering smart pen, or a continuous glucose monitor.
          This section does not limit whether a policy classifies an insulin pump, an electronic
          insulin-administering smart pen, or a continuous glucose monitor as a drug or as a
          medical device or supply.
    SECTION 2. AMENDMENT. Section 26.1-36.6-03 of the North Dakota Century Code is
 amended and reenacted as follows:
    26.1-36.6-03. Self-insurance health plans - Requirements.
     1.   The following policy provisions apply to a self-insurance health plan or to the
          administrative services only or third-party administrator, and are subject to the
          jurisdiction of the commissioner: 26.1-36-03, 26.1-36-03.1, 26.1-36-05, 26.1-36-10,
          26.1-36-12, 26.1-36-12.4, 26.1-36-12.6, 26.1-36-13, 26.1-36-14, 26.1-36-17,
          26.1-36-18, 26.1-36-19, 26.1-36-23, 26.1-36-29, 26.1-36-37.1, 26.1-36-38, 26.1-36-39,
          26.1-36-41, 26.1-36-44, and 26.1-36-46.
     2.   The following health benefit provisions applicable to a group accident and health
          insurance policy under chapter 26.1-36 apply to a self-insurance health plan and are
          subject to the jurisdiction of the commissioner: 26.1-36-06, 26.1-36-06.1, 26.1-36-07,
          26.1-36-08, 26.1-36-08.1, 26.1-36-09, 26.1-36-09.1, 26.1-36-09.2, 26.1-36-09.3,
          26.1-36-09.5, 26.1-36-09.6, 26.1-36-09.7, 26.1-36-09.8, 26.1-36-09.9, 26.1-36-09.10,
          26.1-36-09.11, 26.1-36-09.12, 26.1-36-09.13, 26.1-36-09.14, 26.1-36-09.15,
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         26.1-36-09.16, 26.1-36-11, 26.1-36-12.2, 26.1-36-20, 26.1-36-21, 26.1-36-22,
         26.1-36-23.1, and 26.1-36-43.
    SECTION 3. APPLICATION. This Act applies to a policy delivered, issued, executed, or
 renewed after June 30, 2023.
    SECTION 4. EFFECTIVE DATE. This Act becomes effective July 1, 2023.
    SECTION 5. EMERGENCY. This Act is declared to be an emergency measure.
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Statutes affected: 
INTRODUCED: 26.1-36.6-03
Adopted by the Senate Human Services Committee: 26.1-36.6-03
FIRST ENGROSSMENT: 26.1-36.6-03
Enrollment: 26.1-36.6-03