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North Dakota Senate Bill SB2249

North Dakota 2025-2026 Regular Session

North Dakota Senate Bill SB2249 Compare Versions

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1-Sixty-ninth Legislative Assembly of North Dakota
2-In Regular Session Commencing Tuesday, January 7, 2025
1+25.0138.02001
2+Title.03000
3+Adopted by the Human Services
4+Committee
5+Sixty-ninth
6+January 29, 2025
7+Legislative Assembly
8+of North Dakota
9+Introduced by
10+Senators Barta, Sickler
11+Representatives Bahl, Karls, McLeod
12+A BILL for an Act to create and enact a new section to chapter 54-52.1 of the North Dakota
13+Century Code, relating to step therapy protocol exceptions; to provide for a report to the
14+legislative assembly; to provide for application; and to provide an expiration date.for an Act to
15+provide for a legislative management study relating to health care mandates.
16+BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
17+ SECTION 1. A new section to chapter 54-52.1 of the North Dakota Century Code is created
18+and enacted as follows:
19+ Step therapy protocol exceptions.
20+ 1. As used in this section:
21+ a. "Step therapy protocol" has the same meaning as in section 19-02.1-16.3.
22+ b. "Step therapy protocol exception" means a step therapy protocol is overridden in
23+favor of coverage of the prescription drug selected by a health care professional
24+as provided in subsection 2.
25+ 2. A health carrier, health benefit plan, pharmacy benefits manager, or utilization review
26+agent, shall approve a request for a step therapy protocol exception if:
27+ a. The prescription drug required under the step therapy protocol is contraindicated
28+according to the drug manufacturer's prescribing information for the drug.
29+ b. Due to a documented adverse event with previous use or a documented medical
30+condition, including a comorbid condition, the prescription drug is likely to:
31+ (1) Cause an adverse reaction to a covered individual;
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333 SENATE BILL NO. 2249
4-(Senators Barta, Sickler)
5-(Representatives Bahl, Karls, McLeod)
6-AN ACT to provide for a legislative management study relating to health care mandates.
7-BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
8-SECTION 1. LEGISLATIVE MANAGEMENT STUDY - HISTORICAL HEALTH CARE MANDATES.
9-1.During the 2025-26 interim, the legislative management shall consider studying historical
10-health care mandates. The study must include:
11-a.An analysis of current health care mandates, including when they were enacted, the
12-purpose, effectiveness, and present applicability;
34+PROPOSED AMENDMENTS TO
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56+ (2) Decrease the ability of a covered individual to achieve or maintain
57+reasonable functional ability in performing daily activities; or
58+ (3) Cause physical or mental harm to a covered individual.
59+ c. The prescription drug required under the step therapy protocol is expected to be
60+ineffective based on the known clinical characteristics of the covered individual,
61+including the individual's adherence to or compliance with the plan of care, and:
62+ (1) The known characteristics of the prescription drug regimen as described in
63+peer-reviewed literature or in the manufacturer's prescribing information for
64+the drug;
65+ (2) The health care professional's medical judgment based on clinical practice
66+guidelines or peer-reviewed journals; or
67+ (3) The covered individual's documented experience with the prescription drug
68+regimen.
69+ d. While under the covered individual's current or previous health benefit plan, for a
70+period of time to allow for a positive treatment outcome, the covered individual
71+had a trial of a therapeutically equivalent dose of the prescription drug under a
72+step therapy protocol, and that trial was discontinued by the covered individual's
73+health care professional due to lack of effectiveness.
74+ e. While under the covered individual's current or previous health benefit plan, the
75+covered individual received a positive therapeutic outcome on a prescription drug
76+selected by the covered individual's health care professional for the medical
77+condition under consideration.
78+ 3. A health carrier, health benefit plan, pharmacy benefits manager, or utilization review
79+agent, shall:
80+ a. If the prescription drug is a covered prescription drug under the covered
81+individual's health benefit plan, upon approval of a request supporting a step
82+therapy protocol exception, authorize coverage for the prescription drug selected
83+by the covered individual's health care professional.
84+ b. Except as provided in subdivision c, within five calendar days after the receipt of
85+a request supporting a step therapy protocol exception, make a determination to
86+approve or deny the request.
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120+ c. Within seventy-two hours after the receipt of an emergency or urgent care
121+request supporting a step therapy protocol exception, make a determination to
122+approve or deny the request.
123+ 4. If a health carrier, health plan, pharmacy benefits manager, or utilization review agent
124+fails to respond to a request supporting a step therapy protocol exception as provided
125+in subdivisions b or c of subsection 3, the request is deemed approved.
126+ SECTION 2. PUBLIC EMPLOYEES RETIREMENT SYSTEM - STEP THERAPY
127+PROTOCOL EXCEPTIONS - REPORT TO LEGISLATIVE ASSEMBLY. Pursuant to section
128+54-03-28, the public employees retirement system shall prepare and submit for introduction a
129+bill to the seventieth legislative assembly to repeal the expiration date for this Act and to extend
130+step therapy protocol exception requirements to all group and individual health insurance
131+policies. The public employees retirement system shall append a report to the bill regarding the
132+effect of the step therapy protocol exception requirements on the system's health insurance
133+programs, information on the utilization and costs relating to the requirements, and a
134+recommendation regarding whether the coverage should be continued.
135+ SECTION 3. APPLICATION. This Act applies to health benefits coverage that begins after
136+June 30, 2025, and which does not extend past June 30, 2027.
137+ SECTION 4. EXPIRATION DATE. This Act is effective through June 30, 2027, and after that
138+date is ineffective.
139+SECTION 1. LEGISLATIVE MANAGEMENT STUDY - HISTORICAL HEALTH CARE
140+MANDATES.
141+1.During the 2025-26 interim, the legislative management shall consider studying
142+historical health care mandates. The study must include:
143+a.An analysis of current health care mandates, including when they were enacted,
144+the purpose, effectiveness, and present applicability;
13145 b.A history of health care mandates and step therapy protocol; and
14-c.Input from the department of health and human services, the insurance department, the
15-public employees retirement system, insurance providers and other stakeholders.
16-2.The legislative management shall report its findings and recommendations together with any
17-legislation required to implement the recommendations, to the seventieth legislative assembly. S. B. NO. 2249 - PAGE 2
18-____________________________ ____________________________
19-President of the Senate Speaker of the House
20-____________________________ ____________________________
21-Secretary of the Senate Chief Clerk of the House
22-This certifies that the within bill originated in the Senate of the Sixty-ninth Legislative Assembly of North
23-Dakota and is known on the records of that body as Senate Bill No. 2249.
24-Senate Vote:Yeas 46 Nays 0 Absent 1
25-House Vote: Yeas 75 Nays 9 Absent 10
26-____________________________
27-Secretary of the Senate
28-Received by the Governor at ________M. on _____________________________________, 2025.
29-Approved at ________M. on __________________________________________________, 2025.
30-____________________________
31-Governor
32-Filed in this office this ___________day of _______________________________________, 2025,
33-at ________ o’clock ________M.
34-____________________________
35-Secretary of State
146+c.Input from the department of health and human services, the insurance
147+department, the public employees retirement system, insurance providers and
148+other stakeholders.
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180+2.The legislative management shall report its findings and recommendations together
181+with any legislation required to implement the recommendations, to the seventieth
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