ND SB2258

Prohibits pharmacy benefits managers and third-party payers from charging pharmacies fees that are not apparent at claim processing, not reported on remittance advice, or charged after initial claim adjudication at point of sale.

Requires performance-based pharmacy fees to use electronic quality improvement platforms or nationally recognized entities; prohibits fees on pharmacies meeting established performance criteria and prohibits performance-related fees on cost of goods sold.

Prohibits patient copayments exceeding medication cost and requires pharmacies to retain adjudicated costs when patients make copayments.

Protects pharmacy rights including prohibiting gag orders preventing discussion of affordable alternatives, allowing class action lawsuit participation, permitting mail delivery services with shipping fees, and requiring disclosure of network identification numbers upon request.

Makes violations a class B misdemeanor per occurrence and applies the law to all contracts and agreements effective on or after the act's effective date.