This bill introduces a new section to chapter 26.1-36 of the North Dakota Century Code, focusing on out-of-pocket expenses for prescription drugs. It defines key terms such as "cost-sharing," "enrollee," "health benefit plan," and "prescription drug." The bill mandates that health benefit plans must include any amounts paid by the enrollee or on their behalf when calculating out-of-pocket maximums or cost-sharing requirements for prescription drugs. Additionally, it stipulates that plans cannot vary these amounts based on the availability of cost-sharing assistance programs. If compliance with this section would jeopardize the eligibility of a high-deductible health plan for health savings accounts, the requirements will not apply until the enrollee meets the minimum deductible.

Furthermore, the bill amends section 26.1-36.6-03, detailing the requirements for self-insurance health plans and specifying that certain sections of the law apply to these plans. It clarifies that the new provisions regarding out-of-pocket expenses for prescription drugs will also apply to self-insurance health plans. The bill is set to take effect on January 1, 2026, and will apply to the public employees retirement system uniform group insurance program health insurance benefits, as well as other health benefit plans upon their next renewal after this date.

Statutes affected:
INTRODUCED: 26.1-36.6-03
Adopted by the House Industry, Business and Labor Committee: 26.1-36.6-03
Adopted by the Senate Human Services Committee: 26.1-36.6-03
Prepared by the Legislative Council staff for Representative Karls: 26.1-36.6-03
Enrollment: 26.1-36.6-03
FIRST ENGROSSMENT: 26.1-36.6-03