North Dakota Code 19-02.1-16.3 – Pharmacy benefits managers – Step therapy protocols – Limitations
1. As used in this section:
Terms Used In North Dakota Code 19-02.1-16.3
- Individual: means a human being. See North Dakota Code 1-01-49
- United States: includes the District of Columbia and the territories. See North Dakota Code 1-01-49
a. “Metastatic cancer” means cancer that has spread from the primary or original site to lymph nodes, nearby tissues, or other parts of the body.
b. “Pharmacy benefits manager” has the same meaning as in section 19-03.6-01.
c. “Step therapy protocol” means a protocol requiring an individual use a drug, or sequence of drugs, other than the prescription drug, or sequence of prescription drugs, the individual’s health care provider recommends for the individual’s treatment, before the pharmacy benefits manager or health plan allows coverage for the recommended prescription drug, or sequence of prescription drugs.
2. A pharmacy benefits manager or a health plan may not require a step therapy protocol for coverage of a recommended prescription drug, or sequence of prescription drugs, approved by the United States food and drug administration if:
a. The recommended prescription drug, or sequence of prescription drugs, is prescribed to treat the individual’s diagnosis of metastatic cancer; and
b. The use of the recommended prescription drug, or sequence of prescription drugs, is consistent with the United States food and drug administration-approved indications or is supported by peer-reviewed medical literature.
3. This section does not require coverage of a nonformulary prescription drug.