ND HB1216

Requires health insurers to count third-party payments (such as manufacturer copay assistance programs) toward an enrollee's out-of-pocket maximum and cost-sharing requirements for prescription drugs

Prohibits insurers from designing benefits or varying cost-sharing requirements based on whether an enrollee receives assistance from a drug cost-sharing assistance program

Applies to prescription drugs without a generic equivalent, or drugs with a generic equivalent when the enrollee has obtained access through prior authorization, step therapy, or the appeals process

Includes an exception for high-deductible health plans paired with health savings accounts (HSAs) to maintain tax-qualified status under federal law

Effective January 1, 2026, applying to both commercial health benefit plans and the public employees retirement system group insurance program, as well as self-insurance health plans