This text of North Dakota § 19-02.1-16.6 (Clinician-administered drugs) is published on Counsel Stack Legal Research, covering North Dakota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
1. As used in this section:
a. "Clinician-administered drug" means an outpatient prescription drug other than a:
(1)Vaccine that cannot be reasonably self-administered by the patient to whom
the drug is prescribed;
(2)Vaccine that typically is administered:
(a)By a health care provider authorized under the laws of this state to
administer the drug, including when acting under a physician's
delegation and supervision; and
(b)In a physician's office, hospital outpatient infusion center, pharmacy, or
other clinical setting; or
(3)Specialty drug.
b. "Pharmacy benefits manager" has the same meaning as in section 19-03.6-01.
c. "Specialty drug" has the same meaning as in section 19-02.1-16.2.
d. "Third-party payer" has the same meaning as in section 19-03.6-01.
2. A pharmacy benefits manage
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1. As used in this section:
a. "Clinician-administered drug" means an outpatient prescription drug other than a:
(1) Vaccine that cannot be reasonably self-administered by the patient to whom
the drug is prescribed;
(2) Vaccine that typically is administered:
(a) By a health care provider authorized under the laws of this state to
administer the drug, including when acting under a physician's
delegation and supervision; and
(b) In a physician's office, hospital outpatient infusion center, pharmacy, or
other clinical setting; or
(3) Specialty drug.
b. "Pharmacy benefits manager" has the same meaning as in section 19-03.6-01.
c. "Specialty drug" has the same meaning as in section 19-02.1-16.2.
d. "Third-party payer" has the same meaning as in section 19-03.6-01.
2. A pharmacy benefits manager, third-party payer, or the agent of a pharmacy benefits
manager or third-party payer may not:
a. Require a patient, as a condition of payment or reimbursement, to purchase
pharmacist services, including prescription drugs, exclusively through a mail-
order pharmacy or a pharmacy benefits manager affiliate, or a combination of
both.
b. Increase patient costs if the patient chooses to not use a mail-order pharmacy or
a pharmacy benefits manager affiliate, but instead uses another participating
provider.
c. Interfere with the patient's right to obtain a clinician-administered drug from the
patient's provider of choice.
d. Limit or exclude availability of a clinician-administered drug if not dispensed by a
mail-order pharmacy or pharmacy benefits manager affiliate, if the drug would
otherwise be covered for patients.
e. Condition, deny, restrict, or refuse to authorize or approve, or reduce payment to
a participating provider for a clinician-administered drug if all criteria for medical
necessity are met, because the participating provider did not obtain clinician-
administered drugs from a mail-order pharmacy or pharmacy benefits manager
affiliate.
f. By contract, written policy, or written procedure, require that a pharmacy
designated by the pharmacy benefits manager or third-party payer dispense a
medication directly to a patient with the expectation or intention that the patient
will transport the medication to a health care setting for administration by a
participating provider.
g. By contract, written policy, or written procedure, require that a pharmacy
designated by the pharmacy benefits manager or third-party payer dispense a
medication directly to a health care setting for a participating provider to
administer to a patient.
h. Require the use of a home infusion pharmacy to dispense clinician-administered
drugs to a patient in the home of the patient.