Bill > HB1216

This bill addresses out-of-pocket expenses for prescription drugs in health benefit plans in North Dakota by requiring insurers to include all amounts paid by or on behalf of an enrollee when calculating cost-sharing and out-of-pocket maximums. Specifically, the bill defines key terms like "cost-sharing" (coinsurance, copayments, or deductibles), "enrollee" (an individual with prescription drug coverage), and "prescription drug" (a drug requiring a prescription, either without a generic equivalent or with a generic equivalent obtained through specific processes). The legislation mandates that health benefit plans must count all payments toward an enrollee's out-of-pocket maximum, including those made by the enrollee or on their behalf, and prohibits insurers from adjusting benefit designs to account for cost-sharing assistance programs. The bill includes a provision that exempts high-deductible health plans from these requirements until the minimum deductible is met, to ensure compatibility with health savings account regulations. Additionally, the bill amends existing law to apply these new prescription drug cost-sharing provisions to self-insurance health plans and will take effect on January 1, 2026, applying to public employee insurance programs and other health benefit plans at their next renewal after that date.

Budget and Finance, Business and Industry, Government Affairs

https://ndlegis.gov/assembly/69-2025/regular/bill-overview/bo1216.html