This bill amends section 19-02.1-16.3 of the North Dakota Century Code to establish limitations on step therapy protocols used by pharmacy benefits managers and health plans, particularly concerning the treatment of 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 jeopardize an individual's health if untreated. It prohibits the requirement of step therapy protocols for FDA-approved prescription drugs prescribed for metastatic cancer or its associated conditions, provided that the use aligns with FDA 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. This report is intended to inform future legislative decisions about extending these protocols to all health insurance policies. The bill is set to apply to health insurance benefits starting after June 30, 2025, and will expire on June 30, 2027, unless further action is taken to repeal the expiration date.

Statutes affected:
INTRODUCED: 19-02.1-16.3