This bill amends section 19-02.1-16.3 of the North Dakota Century Code to establish limitations on step therapy protocols specifically for individuals diagnosed with metastatic cancer and associated conditions. The bill introduces new definitions, including "associated condition," which refers to symptoms or side effects related to metastatic cancer that could worsen an individual's health if untreated. It prohibits pharmacy benefits managers and health plans from requiring step therapy protocols for FDA-approved prescription drugs recommended for treating metastatic cancer or its associated conditions, provided that the use of these drugs aligns with FDA-approved indications or is supported by peer-reviewed medical literature.

Additionally, the bill mandates the public employees retirement system to prepare a report for the legislative assembly regarding the impact of step therapy protocols on health insurance programs, including utilization and cost data. The bill applies to health insurance benefits under the uniform group insurance program for coverage beginning after June 30, 2025, and will remain effective until June 30, 2027, after which it will expire unless further action is taken to extend it.

Statutes affected:
INTRODUCED: 19-02.1-16.3