North Dakota Code 19-02.1-16.6 – Clinician-administered drugs
1. As used in this section:
Terms Used In North Dakota Code 19-02.1-16.6
- Contract: A legal written agreement that becomes binding when signed.
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See North Dakota Code 1-01-49
- written: include "typewriting" and "typewritten" and "printing" and "printed" except in the case of signatures and when the words are used by way of contrast to typewriting and printing. See North Dakota Code 1-01-37
a. “Clinician-administered drug” means an outpatient prescription drug other than a: (1) Vaccine that cannot be reasonably self-administered by the patient to whom the drug is prescribed; (2) Vaccine that typically is administered:
(a) By a health care provider authorized under the laws of this state to administer the drug, including when acting under a physician’s delegation and supervision; and
(b) In a physician’s office, hospital outpatient infusion center, pharmacy, or other clinical setting; or
(3) Specialty drug.
b. “Pharmacy benefits manager” has the same meaning as in section 19-03.6-01. c. “Specialty drug” has the same meaning as in section 19-02.1-16.2.
d. “Third-party payer” has the same meaning as in section 19-03.6-01.
2. A pharmacy benefits manager, third-party payer, or the agent of a pharmacy benefits manager or third-party payer may not:
a. Require a patient, as a condition of payment or reimbursement, to purchase pharmacist services, including prescription drugs, exclusively through a mail- order pharmacy or a pharmacy benefits manager affiliate, or a combination of both.
b. Increase patient costs if the patient chooses to not use a mail-order pharmacy or a pharmacy benefits manager affiliate, but instead uses another participating provider.
c. Interfere with the patient’s right to obtain a clinician-administered drug from the patient’s provider of choice.
d. Limit or exclude availability of a clinician-administered drug if not dispensed by a mail-order pharmacy or pharmacy benefits manager affiliate, if the drug would otherwise be covered for patients.
e. Condition, deny, restrict, or refuse to authorize or approve, or reduce payment to a participating provider for a clinician-administered drug if all criteria for medical necessity are met, because the participating provider did not obtain clinician- administered drugs from a mail-order pharmacy or pharmacy benefits manager affiliate.
f. By contract, written policy, or written procedure, require that a pharmacy designated by the pharmacy benefits manager or third-party payer dispense a medication directly to a patient with the expectation or intention that the patient will transport the medication to a health care setting for administration by a participating provider.
g. By contract, written policy, or written procedure, require that a pharmacy designated by the pharmacy benefits manager or third-party payer dispense a medication directly to a health care setting for a participating provider to administer to a patient.
h. Require the use of a home infusion pharmacy to dispense clinician-administered drugs to a patient in the home of the patient.