North Dakota Senate Bill SB2248

North Dakota 2026 1st Special Session

Caption

A BILL for an Act to amend and reenact section 19-02.1-16.3 of the North Dakota Century Code, relating to step therapy protocols; to provide for a report to the legislative assembly; to provide for application; and to provide an expiration date.

Summary

SB2248 aims to amend the North Dakota Century Code regarding step therapy protocols used by pharmacy benefits managers and health plans. Specifically, it prohibits these entities from requiring patients to undergo step therapy for prescription drugs that are FDA-approved for treating metastatic cancer or associated conditions, provided that the prescribed drugs are consistent with FDA indications or supported by peer-reviewed medical literature. The bill also mandates a report to the legislative assembly regarding the effects of these protocols on health insurance programs, including utilization and costs, and a recommendation on whether to continue the coverage beyond the expiration date.

Impact

If enacted, SB2248 would significantly alter the way pharmacy benefits managers and health plans operate in relation to step therapy protocols for patients with metastatic cancer. It would ensure that patients have access to necessary medications without being subjected to potentially harmful delays in treatment. The bill's provisions would apply specifically to health insurance benefits under the uniform group insurance program and would be effective until June 30, 2027, after which it would require further legislative action to continue.

Sentiment

The general sentiment surrounding SB2248 appears to be mixed, as evidenced by its failure to pass. While there may have been support for the intent of the bill to protect patients with metastatic cancer, concerns regarding costs, insurance implications, and the overall impact on healthcare systems may have contributed to its lack of success.

Contention

Notable points of contention likely arose from the balance between patient access to necessary medications and the financial implications for health plans and pharmacy benefits managers. Stakeholders such as healthcare providers may have supported the bill for prioritizing patient care, while insurance representatives may have raised concerns about the potential increase in costs and the implications for insurance coverage policies.