25.1364.01000
Sixty-ninth
Legislative Assembly
of North Dakota
Introduced by
Senators Cleary, Dever, Mathern
Representative McLeod
A BILL for an Act to create and enact a new section to chapter 26.1-36 of the North Dakota
Century Code, relating to individual and group health insurance coverage of insulin drugs and
supplies; and to amend and reenact section 54-52.1-04.18 of the North Dakota Century Code,
relating to health insurance benefits coverage of insulin drugs and supplies.
BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
SECTION 1. A new section to chapter 26.1-36 of the North Dakota Century Code is created
and enacted as follows:
Health insurance benefits coverage - Insulin drug and supply out - of-pocket
limitations.
1.As used in this section:
a."Insulin drug" means a prescription drug that contains insulin and is used to treat
a form of diabetes mellitus. The term does not include an insulin pump, an
electronic insulin-administering smart pen, or a continuous glucose monitor, or
supplies needed specifically for the use of such electronic devices. The term
includes insulin in the following categories:
(1)Rapid-acting insulin;
(2)Short-acting insulin;
(3)Intermediate-acting insulin;
(4)Long-acting insulin;
(5)Premixed insulin product;
(6)Premixed insulin/GLP - 1 RA product; and
(7)Concentrated human regular insulin.
b."Medical supplies for insulin dosing and administration" means supplies needed
for proper insulin dosing, as well as supplies needed to detect or address medical
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emergencies in an individual using insulin to manage diabetes mellitus. The term
does not include an insulin pump, an electronic insulin-administering smart pen,
or a continuous glucose monitor, or supplies needed specifically for the use of
such electronic devices. The term includes:
(1)Blood glucose meters;
(2)Blood glucose test strips;
(3)Lancing devices and lancets;
(4)Ketone testing supplies, such as urine strips, blood ketone meters, and
blood ketone strips;
(5)Glucagon, in injectable and nasal forms;
(6)Insulin pen needles; and
(7)Insulin syringes.
c."Pharmacy or distributor" means a pharmacy or medical supply company, or
other medication or medical supply distributor filling a prescription.
2.An insurance company, nonprofit health service corporation, or health maintenance
organization may not deliver, issue, execute, or renew any health insurance policy,
health service contract, or evidence of coverage on an individual, group, blanket,
franchise, or association basis unless the policy, contract, or evidence of coverage
provides benefits for insulin drug and medical supplies for insulin dosing and
administration which complies with this section.
3.The health benefit plan must limit out - of-pocket costs for a thirty - day supply of:
a.Covered insulin drugs, which may not exceed twenty-five dollars per pharmacy or
distributor, regardless of the quantity or type of insulin drug used to fill the
covered individual's prescription needs.
b.Covered medical supplies for insulin dosing and administration, the total of which
may not exceed twenty-five dollars per pharmacy or distributor, regardless of the
quantity or manufacturer of supplies used to fill the covered individual's
prescription needs.
4.The health benefit plan may not allow a pharmacy benefits manager or the pharmacy
or distributor to charge, require the pharmacy or distributor to collect, or require a
covered individual to make a payment for a covered insulin drug or medical supplies
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for insulin dosing and administration in an amount exceeding the out - of-pocket limits
under subsection 3.
5.The health benefit plan may not impose a deductible, copayment, coinsurance, or
other cost-sharing requirement that causes out - of-pocket costs for prescribed insulin
or medical supplies for insulin dosing and administration to exceed the amount under
subsection 3.
6.Subsection 3 does not require the health benefit plan to implement a particular cost-
sharing structure and does not prevent the limitation of out - of-pocket costs to less than
the amount specified under subsection 3. This section does not limit whether the
health benefit plan classifies an insulin pump, an electronic insulin-administering smart
pen, or a continuous glucose monitor as a drug or as a medical device or supply.
7.If application of subsection 3 would result in the ineligibility of a health benefit plan that
is a qualified high-deductible health plan to qualify as a health savings account under
section 223 of the Internal Revenue Code [26 U.S.C. 223], the requirements of
subsection 3 do not apply with respect to the deductible of the health benefit plan until
after the enrollee has met the minimum deductible under section 26 U.S.C. 223.
8.This section does not apply to the Medicare part D prescription drug coverage plan.
SECTION 2. AMENDMENT. Section 54-52.1-04.18 of the North Dakota Century Code is
amended and reenacted as follows:
54-52.1-04.18. Health insurance benefits coverage - Insulin drug and supply out-of-
pocket limitations. (Expired effective July 31, 2025)
1.As used in this section:
a."Insulin drug" means a prescription drug that contains insulin and is used to treat
a form of diabetes mellitus. The term does not include an insulin pump, an
electronic insulin-administering smart pen, or a continuous glucose monitor, or
supplies needed specifically for the use of such electronic devices. The term
includes insulin in the following categories:
(1)Rapid-acting insulin;
(2)Short-acting insulin;
(3)Intermediate-acting insulin;
(4)Long-acting insulin;
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(5)Premixed insulin product;
(6)Premixed insulin/GLP-1 RA product; and
(7)Concentrated human regular insulin.
b."Medical supplies for insulin dosing and administration" means supplies needed
for proper insulin dosing, as well as supplies needed to detect or address medical
emergencies in an individual using insulin to manage diabetes mellitus. The term
does not include an insulin pump, an electronic insulin-administering smart pen,
or a continuous glucose monitor, or supplies needed specifically for the use of
such electronic devices. The term includes:
(1)Blood glucose meters;
(2)Blood glucose test strips;
(3)Lancing devices and lancets;
(4)Ketone testing supplies, such as urine strips, blood ketone meters, and
blood ketone strips;
(5)Glucagon, in injectable and nasal forms;
(6)Insulin pen needles; and
(7)Insulin syringes.
c."Pharmacy or distributor" means a pharmacy or medical supply company, or
other medication or medical supply distributor filling a covered individual's
prescriptions.
2.The board shall provide health insurance benefits coverage that provides for insulin
drug and medical supplies for insulin dosing and administration which complies with
this sectionas provided under section 1 of this Act .
3.The coverage must limit out-of-pocket costs for a thirty-day supply of:
a.Covered insulin drugs which may not exceed twenty-five dollars per pharmacy or
distributor, regardless of the quantity or type of insulin drug used to fill the
covered individual's prescription needs.
b.Covered medical supplies for insulin dosing and administration, the total of which
may not exceed twenty-five dollars per pharmacy or distributor, regardless of the
quantity or manufacturer of supplies used to fill the covered individual's
prescription needs.
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4.The coverage may not allow a pharmacy benefits manager or the pharmacy or
distributor to charge, require the pharmacy or distributor to collect, or require a
covered individual to make a payment for a covered insulin drug or medical supplies
for insulin dosing and administration in an amount that exceeds the out-of-pocket limits
set forth under subsection 3.
5.The coverage may not impose a deductible, copayment, coinsurance, or other cost-
sharing requirement that causes out-of-pocket costs for prescribed insulin or medical
supplies for insulin dosing and administration to exceed the amount set forth under
subsection 3.
6.Subsection 3 does not require the coverage to implement a particular cost-sharing
structure and does not prevent the limitation of out-of-pocket costs to less than the
amount specified under subsection 3. Subsection 3 does not limit out-of-pocket costs
on an insulin pump, an electronic insulin-administering smart pen, or a continuous
glucose monitor. This section does not limit whether coverage classifies an insulin
pump, an electronic insulin-administering smart pen, or a continuous glucose monitor
as a drug or as a medical device or supply.
7.If application of subsection 3 would result in the ineligibility of a health benefit plan that
is a qualified high-deductible health plan to qualify as a health savings account under
section 223 of the Internal Revenue Code [26 U.S.C. 223], the requirements of
subsection 3 do not apply with respect to the deductible of the health benefit plan until
after the enrollee has satisfied the minimum deductible under section 26 U.S.C. 223.
8.This section does not apply to the Medicare part D prescription drug coverage plan.
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