This text of North Dakota § 26.1-36-09.17 (Out-of-pocket expenses - Prescription 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. "Cost-sharing" means any coinsurance, copayment, or deductible under a health
benefit plan.
b. "Enrollee" means an individual entitled to prescription drug coverage under a
health benefit plan.
c. "Health benefit plan" has the same meaning as provided under section
26.1-36.3-01.
d. "Prescription drug" means a drug for which a prescription is required:
(1)Without a generic equivalent; or
(2)With a generic equivalent, if the enrollee has obtained access to the drug
through prior authorization, a step therapy protocol, or the heath care
insurer's expectations and appeals process.
2. To the extent permitted by federal law and regulation, an insurer may not deliver,
issue, execute, or renew a health benefit plan providing prescription drug coverage
unless when c
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1. As used in this section:
a. "Cost-sharing" means any coinsurance, copayment, or deductible under a health
benefit plan.
b. "Enrollee" means an individual entitled to prescription drug coverage under a
health benefit plan.
c. "Health benefit plan" has the same meaning as provided under section
26.1-36.3-01.
d. "Prescription drug" means a drug for which a prescription is required:
(1) Without a generic equivalent; or
(2) With a generic equivalent, if the enrollee has obtained access to the drug
through prior authorization, a step therapy protocol, or the heath care
insurer's expectations and appeals process.
2. To the extent permitted by federal law and regulation, an insurer may not deliver,
issue, execute, or renew a health benefit plan providing prescription drug coverage
unless when calculating an enrollee's overall contribution to any out-of-pocket
maximum or any cost-sharing requirement for a prescription drug under the health
benefit plan, the health benefit plan provides for the inclusion of any amount paid by
the enrollee or paid on behalf of the enrollee by another person. The health benefit
plan may not vary the out-of-pocket maximum or cost-sharing requirement, or
otherwise design benefits accounting for the availability of a cost-sharing assistance
program for a prescription drug.
3. If application of this section would result in ineligibility of a health benefit plan that is a
qualified high-deductible health plan to qualify as a health savings account under
section 223 of the Internal Revenue Code [26 U.S.C. 223], the requirements of this
section do not apply with respect to the deductible of the health benefit plan until after
the enrollee has satisfied the minimum deductible under section 26 U.S.C. 223.