Sixty-ninth Legislative Assembly of North Dakota
In Regular Session Commencing Tuesday, January 7, 2025
SENATE BILL NO. 2076
(Human Services Committee)
(At the request of the Department of Health and Human Services)
AN ACT to amend and reenact section 50-24.6-04 of the North Dakota Century Code, relating to prior
authorization and certification of medically necessary medication.
BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
SECTION 1. AMENDMENT. Section 50-24.6-04 of the North Dakota Century Code is amended and
reenacted as follows:
50-24.6-04. Prior authorization program - Certification program.
1.The department shall develop and implement a prior authorization program that meets the
requirements of 42 U.S.C. 1396r-8(d) to determine coverage of drug products when a medical
assistance recipient's health care provider prescribes a drug that is identified as requiring prior
authorization. Authorization must be granted for provision of the drug if:
a.The drug not requiring prior authorization has not been effective, or with reasonable
certainty is not expected to be effective, in treating the recipient's condition;
b.The drug not requiring prior authorization causes or is reasonably expected to cause
adverse or harmful reactions to the health of the recipient; or
c.The drug is prescribed for a medically accepted use supported by a compendium or by
approved product labeling unless there is a therapeutically equivalent drug that is
available without prior authorization. The department shall work with the medical
assistance recipient's health care provider to assure treatment can be found for
diagnoses with no compendia supported medications.
2.For any drug placed on the prior authorization program, the department shall provide medical
and clinical criteria, cost information, and utilization data to the drug use review board for
review and consideration. The board may consider department data and information from
other sources to make a decision about placement of the drug on prior authorization.
3.a.For individuals eighteen years of age and older, exceptExcept for quantity limits that may
be no less than the pharmaceutical manufacturer's package insert, brand name drugs
with a generic equivalent drug for which the cost to the state postrebate is less than the
brand name drugs, generic drugs with a brand name equivalent drug for which the cost
to the state postrebate is less than the generic drug, or medications that are considered
line extension drugs, the department may not prior authorize substantially all drugs in the
following medication classes:
(1)Antipsychotics;
(2)Antidepressants;
(3)Anticonvulsants;
(4)Antiretrovirals, for the treatment of human immunodeficiency virus;
(5)Antineoplastic agents; and
(6)Immunosuppressants, for prophylaxis of organ transplant rejection. S. B. NO. 2076 - PAGE 2
b.For individuals under eighteen years of age, except for quantity limits that may be no less
than the pharmaceutical manufacturer's package insert, brand name drugs with a generic
equivalent drug for which the cost to the state postrebate is less than the brand name
drugs, generic drugs with a brand name equivalent drug for which the cost to the state
postrebate is less than the generic drug, or medications that are considered line
extension drugs, the department may not prior authorize substantially all drugs in the
following medication classes:
(1)Antipsychotics;
(2)Antidepressants;
(3)Anticonvulsants;
(4)Antiretrovirals, for the treatment of human immunodeficiency virus;
(5)Antineoplastic agents; and
(6)Immunosuppressants, for prophylaxis of organ transplant rejection.
c.The restrictions of subdivision b do not apply for individuals under eighteen years of age,
who have five or more concurrent prescriptions for psychotropic medications.
d.Prior authorization for individuals under eighteen years of age is required for five or more
concurrent prescriptions for antipsychotics, antidepressants, anticonvulsants,
benzodiazepines, mood stabilizers, sedative, hypnotics, or medications used for the
treatment of attention deficit hyperactivity disorder. The department shall grant
authorization to exceed the limits after a prescriber requesting authorization consults with
a board certified child and adolescent psychiatrist approved by the department.
e.The restrictions of this subsection do not apply if prior authorization is required by the
centers for Medicare and Medicaid services.
f.c.The restrictions of this subsection do not apply to a medication class in subdivision a if a
manufacturer of a drug in that class excludes the department from supplemental rebate
offers or value-based purchasing agreement offers due to the existence of the prior
authorization exclusion in subdivision a.
d.As used in this subsection, "line extension drug" means a new formulation of a drug. The
term does not include an abuse-deterrent formulation of a drug.
g.e.As used in this subsection, "substantially all" means that all drugs and unique dosage
forms in the medication classes outlined in paragraphs 1 through 6 of
subdivisionssubdivision a and b are expected to be covered without prior authorization,
with the following exceptionsexcept:
(1)Multisource brands of the identical molecular structure;
(2)Extended release products when the immediate-release product is included;
(3)Products that have the same active ingredient or moiety; and
(4)Dosage forms that do not provide a unique route of administration.
4.The department may use contractors to collect and analyze the documentation required under
this section and to facilitate the prior authorization program.
5.The department shall consult with the board in the course of adopting rules to implement the
prior authorization program. The rules must: S. B. NO. 2076 - PAGE 3
a.Establish policies and procedures necessary to implement the prior authorization
program.
b.Develop a process that allows prescribers to furnish documentation required to obtain
approval for a drug without interfering with patient care activities.
c.Allow the board to establish panels of physicians and pharmacists which provide expert
guidance and recommendations to the board in considering specific drugs or therapeutic
classes of drugs to be included in the prior authorization program.
6.The department may negotiate additional rebates from drug manufacturers to supplement the
rebates required by federal law governing the medical assistance program. Additionally, the
department may join a multistate supplemental drug rebate pool, and if the department
negotiates additional rebates outside this pool, any other manufacturer must be allowed to
match those rebates.
7.The department shall develop a certification program to verify the medical necessity of each
medication in a regimen containing five or more concurrent prescriptions for antipsychotic,
antidepressant, anticonvulsant, benzodiazepine, mood stabilizer, sedative hypnotic, or
attention deficit hyperactivity disorder medications.
a.The certification program shall require each prescriber of a medication in an impacted
regimen to certify annually the medication prescribed is medically necessary for the
patient.
b.If a prescriber does not certify a medication as a medically necessary part of the patient's
regimen, the department may deny payment of the medication until the medication is
certified by the prescriber.
c.The certification program shall apply to individuals under the age of twenty - two and may
apply to other individuals at the discretion of the department. S. B. NO. 2076 - PAGE 4
____________________________ ____________________________
President of the Senate Speaker of the House
____________________________ ____________________________
Secretary of the Senate Chief Clerk of the House
This certifies that the within bill originated in the Senate of the Sixty-ninth Legislative Assembly of North
Dakota and is known on the records of that body as Senate Bill No. 2076.
Senate Vote:Yeas 46 Nays 0 Absent 1
House Vote: Yeas 92 Nays 0 Absent 2
____________________________
Secretary of the Senate
Received by the Governor at ________M. on _____________________________________, 2025.
Approved at ________M. on __________________________________________________, 2025.
____________________________
Governor
Filed in this office this ___________day of _______________________________________, 2025,
at ________ o’clock ________M.
____________________________
Secretary of State