Pharmacy claim fees and pharmacy rights - Pharmacy benefits managers - Penalty
N.D. Cent. Code § 19-02.1-16.1
in effect19-02.1-16.1. Pharmacy claim fees and pharmacy rights - Pharmacy benefits
managers - Penalty.
1. As used in this section:
a. "Pharmacy benefits manager" has the same meaning as in section 19-03.6-01.
b. "Plan sponsor" has the same meaning as in section 19-03.6-01.
c. "Third-party payer" has the same meaning as in section 19-03.6-01.
2. A pharmacy benefits manager or third-party payer may not directly or indirectly charge
or hold a pharmacy responsible for a fee related to a claim:
a. That is not apparent at the time of claim processing;
b. That is not reported on the remittance advice of an adjudicated claim; or
c. After the initial claim is adjudicated at the point of sale.
3. Pharmacy performance measures or pay for performance pharmacy networks shall
utilize the electronic quality improvement platform for plans and pharmacies or other
unbiased nationally recognized entity aiding in improving pharmacy performance
measures.
a. A pharmacy benefits manager or third-party payer may not collect a fee from a
pharmacy if the pharmacy's performance scores or metrics fall within the criteria
identified by the electronic quality improvement platform for plans and
pharmacies or other unbiased nationally recognized entity aiding in improving
pharmacy performance measures.
b. If a pharmacy benefits manager or third-party payer imposes a fee upon a
pharmacy for scores or metrics or both scores and metrics that do not meet those
established by the electronic quality improvement platform for plans and
pharmacies or other nationally recognized entity aiding in improving pharmacy
performance measures, a pharmacy benefits manager or third-party payer is
limited to applying the fee to the professional dispensing fee outlined in the
pharmacy contract.
c. A pharmacy benefits manager or third-party payer may not impose a fee relating
to performance metrics on the cost of goods sold by a pharmacy.
4. A pharmacy benefits manager or third-party payer may not charge a patient a
copayment that exceeds the cost of the medication. If a patient pays a copayment, the
dispensing provider or pharmacy shall retain the adjudicated cost and the pharmacy
benefits manager or third-party payer may not redact the adjudicated cost.
5. A pharmacy benefits manager or third-party payer may not prohibit a pharmacist or
pharmacy from participating in a class action lawsuit. A pharmacy or pharmacist may
disclose to the plan sponsor or to the patient information regarding the adjudicated
reimbursement paid to the pharmacy which is compliant under the federal Health
Insurance Portability and Accountability Act of 1996 [Pub. L. 104-191; 110 Stat. 1936;
29 U.S.C. 1181 et seq.].
6. A pharmacist or pharmacy that belongs to a pharmacy service administration
organization may receive a copy of a contract the pharmacy service administration
organization entered with a pharmacy benefits manager or third-party payer on the
pharmacy's or pharmacist's behalf.
7. A pharmacy or pharmacist may provide relevant information to a patient if the patient is
acquiring prescription drugs. This information may include the cost and clinical efficacy
of a more affordable alternative drug if one is available. Gag orders of such a nature
placed on a pharmacy or pharmacist are prohibited.
8. A pharmacy or pharmacist may mail or deliver drugs to a patient as an ancillary
service of a pharmacy.
9. A pharmacy benefits manager or third-party payer may not prohibit a pharmacist or
pharmacy from charging a shipping and handling fee to a patient requesting a
prescription be mailed or delivered.
10. Upon request, a pharmacy benefits manager or third-party payer shall provide a
pharmacy or pharmacist with the processor control number, bank identification
number, and group number for each pharmacy network established or administered by
a pharmacy benefits manager to enable the pharmacy to make an informed
contracting decision.
11. A pharmacy benefits manager or third-party payer may not require pharmacy
accreditation standards or recertification requirements inconsistent with, more
stringent than, or in addition to federal and state requirements for licensure as a
pharmacy in this state.
12. A pharmacy benefits manager or other third-party payer that violates this section is
guilty of a class B misdemeanor per violation occurrence.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://ndlegis.gov/cencode/t19c02-1.pdf#nameddest=19-02p1-16p1Fetched: 10/16/2026