Prescription drug coverage - Performance audits
N.D. Cent. Code § 54-52.1-04.16
in effect54-52.1-04.16. Prescription drug coverage - Performance audits
1. Except for Medicare part D, prescription drug coverage, the board may not enter or
renew a contract for prescription drug coverage unless the contract authorizes the
board during the term of the contract to conduct a performance audit of the
prescription drug coverage and any related pharmacy benefits management services.
The contract must provide:
a. The board must have full access to data regarding:
(1) The total dollars paid to the pharmacy benefits manager by the carrier and
the board;
(2) The total amount of dollars paid to the pharmacy benefits manager by the
carrier which were not subsequently paid to a licensed pharmacy in the
state; and
(3) Payments made to all pharmacy providers.
b. The board must have full access to data regarding the average reimbursement,
by drug ingredient cost, dispensing fee, and any other fee paid by a pharmacy
benefits manager to licensed pharmacies with which the pharmacy benefits
manager shares common ownership or control or is affiliated.
c. The board must have full access to data regarding the average reimbursement,
by drug ingredient cost, dispensing fee, and any other fee paid by a pharmacy
benefits manager to pharmacies licensed in the state.
d. The board must have full access to data regarding any direct and indirect fees,
charges, or recoupment, or any kind of assessments imposed by the pharmacy
benefits manager on pharmacies licensed with which the pharmacy benefits
manager shares common ownership or control or is affiliated.
e. The board must have full access to data regarding any direct and indirect fees,
charges, or recoupment, or any kind of assessments imposed by the pharmacy
benefits manager, on pharmacies licensed in the state.
f. The contract must provide that all drug rebates, financial incentives, fees, and
discounts must be disclosed to the board.
2. The board shall use an independent auditor who has no conflict of interest with the
carrier, pharmacy benefits manager, or board. The board's auditor, the insurance
department, and the employee benefits programs committee may access any
information the board may access under this section. All information accessed by the
board, board's auditor, insurance department, or employee benefits programs
committee which is trade secret is a confidential record. This subsection does not limit
the information required to be disclosed to the board under subsection 1.
3. Except for Medicare part D, if the board contracts directly with a pharmacy benefits
manager or provides prescription drug coverage through a self-insurance plan, the
contract must provide the pharmacy benefits manager shall disclose to the board and
the board's auditor all rebates and any other fees that provide the pharmacy benefits
manager with sources of income under the contract, including under related contracts
the pharmacy benefits manager has with third parties, such as drug manufacturers.
4. Anything the board has access to under this section, the insurance department and
employee benefits programs committee has access to.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://ndlegis.gov/cencode/t54c52-1.pdf#nameddest=54-52p1-04p16Fetched: 10/16/2026