ND HB1363

Pharmacy benefits managers must provide to contracted pharmacies the sources used to determine maximum allowable cost pricing at the beginning of each contract and renewal.

Maximum allowable cost price lists must be updated at least every seven business days with prompt notification to network pharmacies, and sources must be disclosed on each list in an accessible format.

Maximum allowable cost prices cannot be set below the sources used by the pharmacy benefits manager, and dispensing fees must be excluded from reimbursement calculations.

Pharmacy benefits managers must provide a reasonable appeals procedure allowing pharmacies to contest maximum allowable prices, with determinations issued within seven business days and adjustments applied to all similarly situated pharmacy providers statewide.

Prescription drugs can only be placed on maximum allowable cost lists if they have at least two nationally available therapeutically equivalent drugs, are rated "A" or "B" (or "Z" rated) by the FDA Orange Book, and are generally available from national or regional wholesalers; violations are class B misdemeanors.