N.D. Cent. Code § 19-02.1-16.6: Clinician-administered drugs

1.As used in this section:

a."Clinician-administered drug" means an outpatient prescription drug other than a:

(1)Vaccine that cannot be reasonably self-administered by the patient to whom the drug is prescribed;

(2)Vaccine that typically is administered:

(a)By a health care provider authorized under the laws of this state to administer the drug, including when acting under a physician's delegation and supervision; and

(b)In a physician's office, hospital outpatient infusion center, pharmacy, or other clinical setting; or

(3)Specialty drug.

b."Pharmacy benefits manager" has the same meaning as in section 19-03.6-01.

c."Specialty drug" has the same meaning as in section 19-02.1-16.2.

d."Third-party payer" has the same meaning as in section 19-03.6-01.

2.A pharmacy benefits manager, third-party payer, or the agent of a pharmacy benefits manager or third-party payer may not:

a.Require a patient, as a condition of payment or reimbursement, to purchase pharmacist services, including prescription drugs, exclusively through a mail- order pharmacy or a pharmacy benefits manager affiliate, or a combination of both.

b.Increase patient costs if the patient chooses to not use a mail-order pharmacy or a pharmacy benefits manager affiliate, but instead uses another participating provider.

c.Interfere with the patient's right to obtain a clinician-administered drug from the patient's provider of choice.

d.Limit or exclude availability of a clinician-administered drug if not dispensed by a mail-order pharmacy or pharmacy benefits manager affiliate, if the drug would otherwise be covered for patients.

e.Condition, deny, restrict, or refuse to authorize or approve, or reduce payment to a participating provider for a clinician-administered drug if all criteria for medical necessity are met, because the participating provider did not obtain clinician- administered drugs from a mail-order pharmacy or pharmacy benefits manager affiliate.

f.By contract, written policy, or written procedure, require that a pharmacy designated by the pharmacy benefits manager or third-party payer dispense a medication directly to a patient with the expectation or intention that the patient will transport the medication to a health care setting for administration by a participating provider.

g.By contract, written policy, or written procedure, require that a pharmacy designated by the pharmacy benefits manager or third-party payer dispense a medication directly to a health care setting for a participating provider to administer to a patient.

h.Require the use of a home infusion pharmacy to dispense clinician-administered drugs to a patient in the home of the patient.