This text of North Dakota § 26.1-36.11-02 (Required coverage for comprehensive medication management services) 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.
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1. A health carrier shall provide coverage for licensed pharmacists to provide
comprehensive medication management to eligible enrollees who elect to participate
in a comprehensive medication management program.
2. At least annually, the health carrier shall provide, in print, or electronically under the
provisions of section 26.1-02-32, notice of an enrollee's eligibility to receive
comprehensive medication management services from a pharmacist, delivered to the
eligible enrollee and the enrollee's designated primary care provider, if applicable, and
if at least one of the following criteria are met:
a. The enrollee is taking five or more chronic medications;
b. The enrollee was admitted to a hospital with one of the following diagnoses:
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1. A health carrier shall provide coverage for licensed pharmacists to provide
comprehensive medication management to eligible enrollees who elect to participate
in a comprehensive medication management program.
2. At least annually, the health carrier shall provide, in print, or electronically under the
provisions of section 26.1-02-32, notice of an enrollee's eligibility to receive
comprehensive medication management services from a pharmacist, delivered to the
eligible enrollee and the enrollee's designated primary care provider, if applicable, and
if at least one of the following criteria are met:
a. The enrollee is taking five or more chronic medications;
b. The enrollee was admitted to a hospital with one of the following diagnoses:
(1) Heart failure;
(2) Pneumonia;
(3) Myocardial infarction;
(4) Mood disorder; or
(5) Chronic obstructive pulmonary disorder; or
c. The enrollee has active diagnosis of comorbid diabetes and:
(1) Hypertension; or
(2) Hyperlipemia.
3. Comprehensive medication management services may be provided via telehealth as
defined in section 26.1-36-09.15 and may be delivered into an enrollee's residence.
4. The health carrier shall include an adequate number of pharmacists in the carrier's
network of participating pharmacy providers.
a. The participation of pharmacists and pharmacies in the health carrier network's or
health carrier's affiliate network's drug benefit does not satisfy the requirement
that health benefit plans include pharmacists in the health benefit plan's networks
of participating pharmacy providers.
b. For health benefit plans issued or renewed after December 31, 2024, health
carriers that delegate credentialing agreements to contracted health care facilities
shall accept credentialing for pharmacists employed or contracted by those
facilities. Health carriers shall reimburse facilities for covered services provided
by network pharmacists within the pharmacists' scope of practice per negotiations
with the facility.
5. The health carrier shall post electronically a current and accurate directory of
pharmacists who are participating pharmacy providers and eligible to provide
comprehensive medication management.
a. In making the directory available electronically, the health carrier shall ensure the
general public is able to view all of the current providers for a plan through a
clearly identifiable link or tab and without creating or accessing an account or
entering a policy or contract.
b. The health carrier shall ensure that one hundred percent of provider directory
entries are audited annually for accuracy and retain documentation of the audit to
be made available to the commissioner upon request.
c. The health carrier shall provide a print copy of current electronic directory
information upon request of an enrollee or a prospective enrollee.
d. The electronically posted directory must include search functionality that enables
electronic searches by each of the following:
(1) Name;
(2) Participating location;
(3) Participating facility affiliations, if applicable;
(4) Languages spoken other than English, if applicable; and
(5) Whether accepting new enrollees.
6. The requirements of this section apply to all health benefit plans issued or renewed
after December 31, 2024.