AN ACT to create and enact two new sections to chapter 43-15 and a new subsection to section 43-48-03 of the North Dakota Century Code, relating to the prescriptive authority of pharmacists and therapeutic substitution; to amend and reenact subsection 1 of section 26.1-36.11-01 and section 43-15-01 of the North Dakota Century Code, relating to the scope of practice of pharmacists; to repeal section 43-15-25.3 of the North Dakota Century Code, relating to approved laboratory tests; and to provide an effective date.
SB 2402 expands and clarifies the scope of pharmacy practice in North Dakota, with a particular focus on pharmacist prescriptive authority and therapeutic substitution. The bill amends the Century Code definitions governing pharmacy practice and comprehensive medication management, and it creates new statutory authority allowing pharmacists physically located in the state to independently prescribe certain drugs and devices under specified conditions. Those conditions include being educationally prepared for the condition treated, operating under a patient-pharmacist relationship, using patient assessment protocols, documenting care, consulting or referring when appropriate, and notifying a patient’s primary care provider when one is identified.
The bill lists several categories of medications and devices pharmacists may prescribe, including treatments for lice, cold sores, motion sickness, hypoglycemia, influenza, strep throat, COVID-19, HIV postexposure prophylaxis, asthma rescue therapy in limited circumstances, travel medicine drugs after approved training, emergency medications such as diphenhydramine, epinephrine, and short-acting beta agonists, and Lyme disease prophylaxis. It also authorizes pharmacists to prescribe certain FDA-approved devices such as inhalation spacers, nebulizers, diabetes testing supplies, pen needles, and epinephrine auto-injectors. In addition, the bill permits pharmacists to substitute therapeutically equivalent drugs in many cases, while excluding several categories such as antidepressants, antipsychotics, chemotherapy agents, Schedule II controlled substances, biological products, and narrow therapeutic index drugs.
The bill’s impact on state law is significant because it formally broadens pharmacist authority within chapter 43-15 and ties that authority to clinical protocols, documentation, and patient notification requirements. It also repeals section 43-15-25.3, which previously governed approved laboratory tests, while folding laboratory testing references into the updated pharmacy practice framework. The measure further amends the definition of comprehensive medication management in the insurance code, which may affect how pharmacy services are described or covered in health benefit contexts. Overall, the bill would make pharmacists a more active point of access for limited prescribing, testing-related care, and medication substitution decisions.
The general sentiment reflected in the bill’s final passage was strongly favorable. The recorded votes were overwhelmingly in support, with unanimous or near-unanimous approval in both chambers and only one dissenting House vote. No committee transcript was provided, but the broad vote margins suggest the measure was viewed as a practical expansion of access to care and pharmacy services rather than a controversial overhaul. The bill’s immediate filing with the Secretary of State also indicates it moved through the process as a completed enactment without apparent delay.
The main points of potential contention are the scope and limits of pharmacist autonomy. The bill allows independent prescribing, but only for enumerated conditions or under tightly defined circumstances, and it requires clinical protocols, follow-up plans, and provider notification. Another possible concern is therapeutic substitution, particularly because it permits pharmacists to substitute drugs that are not identical active ingredients, which may raise questions about prescriber control, patient consent, and clinical appropriateness. The exclusions for certain drug classes and the requirement that substitutions provide cost or access benefits appear designed to address those concerns while still expanding pharmacist flexibility.
SB 2402 amends North Dakota pharmacy law to expand pharmacist scope of practice, authorize limited independent prescribing, permit therapeutic substitution under specified safeguards, and update related definitions in the insurance and pharmacy codes. It also repeals the separate statute governing approved laboratory tests and incorporates laboratory-related authority into the broader pharmacy practice framework. The bill affects pharmacists, prescribers, patients, pharmacies, and potentially insurers or benefit administrators that rely on the statutory definition of comprehensive medication management.
The likely areas of contention are the expansion of pharmacist prescriptive authority and the ability of pharmacists to substitute therapeutically equivalent drugs without a new prescriber order. Critics could view these provisions as encroaching on physician or other prescriber authority, while supporters would likely emphasize access, convenience, and timely treatment. The bill tries to limit controversy by excluding higher-risk drug classes, requiring patient counseling and consent, mandating provider notification, and restricting prescribing to conditions and protocols for which the pharmacist is trained.