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Current as of January 01, 2024 | Updated by Findlaw Staff
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.
Cite this article: FindLaw.com - North Dakota Century Code Title 19. Foods, Drugs, Oils, and Compounds § 19-02.1-16.3. Pharmacy benefits managers--Step therapy protocols--Limitations - last updated January 01, 2024 | https://codes.findlaw.com/nd/title-19-foods-drugs-oils-and-compounds/nd-cent-code-sect-19-02-1-16-3/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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