North Dakota Century Code Title 26.1. Insurance § 26.1-27.1-01. Definitions

1. “Covered entity” means a nonprofit hospital or a medical service corporation; a health insurer; a health benefit plan; a health maintenance organization; a health program administered by the state in the capacity of provider of health coverage; or a labor union, or other entity organized in the state which provides health coverage to covered individuals who are employed or reside in the state. The term does not include a plan issued for coverage for federal employees; or a health plan that provides coverage only for accidental injury, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care, or other limited-benefit health insurance policies or contracts that do not include prescription drug coverage.

2. “Covered individual” means a member, a participant, an enrollee, a contractholder, a policyholder, or a beneficiary of a covered entity who is provided health coverage by the covered entity. The term includes a dependent or other individual provided health coverage through a policy, contract, or plan for a covered individual.

3. “De-identified information” means information from which the name, address, telephone number, and other variables have been removed in accordance with requirements of title 45, Code of Federal Regulations, part 164, section 512, subsections (a) or (b).

4. “Labeler” means a person that has been assigned a labeler code by the federal food and drug administration under title 21, Code of Federal Regulations, part 207, section 20, and that receives prescription drugs from a manufacturer or wholesaler and repackages those drugs for later retail sale.

5. “Payment received by the pharmacy benefits manager” means the aggregate amount of the following types of payments:

6. “Pharmacy benefits management” means the procurement of prescription drugs at a negotiated rate for dispensation within this state to covered individuals; the administration or management of prescription drug benefits provided by a covered entity for the benefit of covered individuals; or the providing of any of the following services with regard to the administration of the following pharmacy benefits:

7. “Pharmacy benefits manager” means a person who performs pharmacy benefits management, as a third party, under a contract or other financial arrangement with a covered entity. The term does not include a health benefit plan that manages or directs its own pharmacy benefits.

8. “Rebate” means a retrospective reimbursement of a monetary amount by a manufacturer under a manufacturer's discount program with a pharmacy benefits manager for drugs dispensed to a covered individual.

9. “Utilization information” means de-identified information regarding the quantity of drug prescriptions dispensed to members of a health plan during a specified time period.