Pharmacy benefits managers - Step therapy protocols - Limitations
N.D. Cent. Code § 19-02.1-16.3
in effect19-02.1-16.3. Pharmacy benefits managers - Step therapy protocols - Limitations
1. As used in this section:
a. "Metastatic cancer" means cancer that has spread from the primary or original
site to lymph nodes, nearby tissues, or other parts of the body.
b. "Pharmacy benefits manager" has the same meaning as in section 19-03.6-01.
c. "Step therapy protocol" means a protocol requiring an individual use a drug, or
sequence of drugs, other than the prescription drug, or sequence of prescription
drugs, the individual's health care provider recommends for the individual's
treatment, before the pharmacy benefits manager or health plan allows coverage
for the recommended prescription drug, or sequence of prescription drugs.
2. A pharmacy benefits manager or a health plan may not require a step therapy protocol
for coverage of a recommended prescription drug, or sequence of prescription drugs,
approved by the United States food and drug administration if:
a. The recommended prescription drug, or sequence of prescription drugs, is
prescribed to treat the individual's diagnosis of metastatic cancer; and
b. The use of the recommended prescription drug, or sequence of prescription
drugs, is consistent with the United States food and drug administration-approved
indications or is supported by peer-reviewed medical literature.
3. This section does not require coverage of a nonformulary prescription drug.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://ndlegis.gov/cencode/t19c02-1.pdf#nameddest=19-02p1-16p3Fetched: 10/16/2026