The bill amends section 50-24.6-04 of the North Dakota Century Code to enhance the prior authorization program for medically necessary medications. It establishes a certification program to verify the medical necessity of medications prescribed in regimens containing five or more concurrent prescriptions for specific classes of drugs, including antipsychotics and antidepressants. The department is required to develop this certification program, which mandates annual certification by prescribers that the medications are medically necessary. If a prescriber fails to certify a medication, the department may deny payment until certification is provided.
Additionally, the bill modifies existing provisions regarding prior authorization for certain drug classes, removing age-specific restrictions and allowing for broader application across all age groups. It specifies that the department cannot prior authorize substantially all drugs in certain medication classes unless specific conditions are met, such as the existence of a therapeutically equivalent drug available without prior authorization. The bill also introduces new definitions and clarifications regarding "line extension drugs" and the criteria for what constitutes "substantially all" drugs in the specified classes. Overall, the changes aim to streamline the authorization process while ensuring that medically necessary medications are accessible to patients.
Statutes affected:
PREFILED: 50-24.6-04
Adopted by the House Human Services Committee: 50-24.6-04
Enrollment: 50-24.6-04
INTRODUCED: 50-24.6-04