This bill proposes the creation of a new section in the North Dakota Century Code that addresses out-of-pocket expenses for prescription drugs. It defines key terms such as "cost-sharing," "enrollee," "health benefit plan," and "prescription drug," and establishes that insurers cannot issue or renew health benefit plans providing prescription drug coverage unless they include amounts paid by the enrollee towards the out-of-pocket maximum or cost-sharing requirements. Additionally, the bill stipulates that health benefit plans cannot adjust these requirements based on the availability of cost-sharing assistance programs for prescription drugs. It also provides an exception for high-deductible health plans regarding the application of these requirements until the enrollee meets the minimum deductible.

Furthermore, the bill amends existing provisions related to self-insurance health plans, ensuring that the new section on out-of-pocket expenses applies to these plans and is subject to the jurisdiction of the commissioner. The amendments clarify which sections of the law apply to self-insurance health plans, both during the current effective period and after July 31, 2025. The bill aims to enhance transparency and fairness in the calculation of out-of-pocket costs for prescription drugs while ensuring that self-insurance health plans adhere to the same standards.

Statutes affected:
INTRODUCED: 26.1-36.6-03