The proposed amendments to Senate Bill No. aim to enhance the prior authorization program for medication coverage under North Dakota's medical assistance program. The bill introduces a certification program to verify the medical necessity of medications prescribed to patients on five or more concurrent prescriptions for specific classes of drugs, including antipsychotics and antidepressants. The department will require prescribers to certify annually that the medications are medically necessary, and if a prescriber fails to do so, the department may deny payment for the medication until certification is provided. This certification program will primarily apply to individuals under the age of twenty-two, with the possibility of extending to other individuals at the department's discretion.

Additionally, the bill amends existing language regarding the prior authorization process, removing age-specific restrictions on the authorization of certain medication classes. It clarifies that the department may not prior authorize substantially all drugs in specified classes, with exceptions for certain circumstances, such as when a manufacturer excludes the department from rebate offers due to prior authorization exclusions. The amendments also emphasize the department's ability to negotiate additional rebates from drug manufacturers and to utilize contractors for documentation analysis related to the prior authorization program. Overall, the bill seeks to streamline the medication approval process while ensuring that prescribed medications are medically necessary for patients.

Statutes affected:
INTRODUCED: 50-24.6-04
Adopted by the House Human Services Committee: 50-24.6-04
PREFILED: 50-24.6-04