1.    A health carrier shall provide coverage for licensed pharmacists to provide comprehensive medication management to eligible enrollees who elect to participate in a comprehensive medication management program.

2.    At least annually, the health carrier shall provide, in print, or electronically under the provisions of section 26.1-02-32, notice of an enrollee’s eligibility to receive comprehensive medication management services from a pharmacist, delivered to the eligible enrollee and the enrollee’s designated primary care provider, if applicable, and if at least one of the following criteria are met:

a.    The enrollee is taking five or more chronic medications; b.    The enrollee was admitted to a hospital with one of the following diagnoses: (1) Heart failure; (2) Pneumonia; (3) Myocardial infarction; (4) Mood disorder; or

(5) Chronic obstructive pulmonary disorder; or

c.    The enrollee has active diagnosis of comorbid diabetes and: (1) Hypertension; or

(2) Hyperlipemia.

3.    Comprehensive medication management services may be provided via telehealth as defined in section 26.1-36-09.15 and may be delivered into an enrollee’s residence.

4.    The health carrier shall include an adequate number of pharmacists in the carrier’s network of participating pharmacy providers.

a.    The participation of pharmacists and pharmacies in the health carrier network’s or health carrier’s affiliate network’s drug benefit does not satisfy the requirement that health benefit plans include pharmacists in the health benefit plan’s networks of participating pharmacy providers.

b.    For health benefit plans issued or renewed after December 31, 2024, health carriers that delegate credentialing agreements to contracted health care facilities shall accept credentialing for pharmacists employed or contracted by those facilities. Health carriers shall reimburse facilities for covered services provided by network pharmacists within the pharmacists’ scope of practice per negotiations with the facility.

5.    The health carrier shall post electronically a current and accurate directory of pharmacists who are participating pharmacy providers and eligible to provide comprehensive medication management.

a.    In making the directory available electronically, the health carrier shall ensure the general public is able to view all of the current providers for a plan through a clearly identifiable link or tab and without creating or accessing an account or entering a policy or contract.

b.    The health carrier shall ensure that one hundred percent of provider directory entries are audited annually for accuracy and retain documentation of the audit to be made available to the commissioner upon request.

c. The health carrier shall provide a print copy of current electronic directory information upon request of an enrollee or a prospective enrollee.

d.    The electronically posted directory must include search functionality that enables electronic searches by each of the following: (1) Name; (2) Participating location; (3) Participating facility affiliations, if applicable; (4) Languages spoken other than English, if applicable; and

(5) Whether accepting new enrollees.

6.    The requirements of this section apply to all health benefit plans issued or renewed after December 31, 2024.