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 authority of pharmacists in North Dakota to provide certain clinical services. It amends the pharmacy chapter to update definitions and the scope of practice, and it creates new sections allowing pharmacists, under specified conditions, to independently prescribe certain drugs and devices, perform therapeutic substitution, and continue to provide related medication-management services. The bill also repeals the existing statute governing approved laboratory tests and folds laboratory-testing references into the updated pharmacy framework.
Under the bill, pharmacists may prescribe a defined list of medications and devices for specific conditions such as lice, cold sores, motion sickness, hypoglycemia, influenza, strep throat, COVID-19, HIV postexposure prophylaxis, asthma rescue therapy, travel medicine needs, emergency allergy/asthma treatment, and Lyme disease prophylaxis. The bill also permits pharmacists to substitute therapeutically equivalent drugs in many cases, while excluding certain categories such as antidepressants, antipsychotics, chemotherapy agents, Schedule II controlled substances, biological products, and narrow therapeutic index drugs. It requires patient counseling, notice to prescribers, documentation, and use of clinical protocols and follow-up care plans.
The bill’s impact on state law is to broaden the role of pharmacists within North Dakota’s health care system while preserving guardrails around training, patient assessment, referral, and communication with other providers. It also updates the statutory definition of the practice of pharmacy to reflect prescriptive practices, laboratory testing, and emergency pharmacy practice, and it makes conforming changes to the state’s medication-management statute. The effective date is immediate upon filing with the secretary of state.
The overall sentiment appears strongly favorable. The bill passed the Senate unanimously and the House by a wide margin, with only one dissenting vote, suggesting broad bipartisan support for expanding pharmacist access to care and medication management services. The absence of committee transcript material limits insight into detailed debate, but the voting record indicates little organized opposition.
The main points of contention, as reflected in the text, are not about whether pharmacists should have a larger role, but about how far that role should extend and what limits should apply. The bill addresses those concerns by restricting prescriptive authority to conditions and drugs for which the pharmacist is trained, requiring protocols and referral criteria, and excluding higher-risk drug classes from therapeutic substitution. Any concern from opponents would likely center on patient safety, scope-of-practice boundaries, and coordination with physicians and other prescribers, while supporters likely emphasize access, convenience, and timely treatment.
The bill amends North Dakota Century Code chapters governing pharmacy practice and medication management, expanding pharmacists’ statutory authority to prescribe certain medications and devices, perform limited therapeutic substitution, and engage in related clinical activities under defined standards. It also repeals the separate statute on approved laboratory tests and incorporates laboratory-testing references into the revised pharmacy framework, while making conforming changes to the definition of comprehensive medication management and the general definition of the practice of pharmacy. These changes directly affect pharmacists, prescribers, patients seeking routine or protocol-based treatment, and the state board of pharmacy, which is given a role in approving protocols and receiving notice of certain practices.
The bill appears to have enjoyed broad support in both chambers, passing the Senate 46-0 and the House 91-1. That voting pattern suggests a generally positive view of pharmacist-led access to care, especially for common conditions and medication access issues. With no committee transcripts available, the record does not show substantial public disagreement, and the near-unanimous votes indicate that any concerns were outweighed by support for the bill’s access and efficiency goals.
The principal policy tension in SB 2402 is between expanding access to care through pharmacist prescriptive authority and preserving patient safety and traditional prescriber oversight. The bill’s supporters appear to favor allowing pharmacists to treat routine conditions, close care gaps, and substitute therapeutically equivalent drugs when appropriate. Potential critics would likely focus on whether pharmacists should independently prescribe medications, whether substitution could affect continuity of care, and whether the exclusions for certain drug classes are sufficient. The bill responds to those concerns by requiring patient assessment protocols, documentation, referral criteria, follow-up plans, and prompt notice to the patient’s primary care provider or provider of record.