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 these plans cannot vary their out-of-pocket maximums or cost-sharing based on the availability of cost-sharing assistance programs. There is also a provision that exempts certain high-deductible health plans from these requirements until the enrollee meets the minimum deductible as defined by federal law.

Furthermore, the bill amends section 26.1-36.6-03, which pertains to self-insurance health plans, by incorporating specific sections of the North Dakota Century Code that 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 and are subject to the jurisdiction of the commissioner. 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 coverage, as well as to 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