ND HB1584

Requires pharmacy benefits managers (PBMs) to obtain a license from the insurance commissioner with initial and renewal fees up to $10,000, evidence of $1 million financial responsibility, and makes operating without a license a class C felony

Prohibits PBMs from requiring pharmacies to participate in one contract to join another network, mandates opt-in contracts with 30-day response periods, and allows pharmacies to opt-out with 90-day notice

Establishes administrative penalties including up to $10,000 per violation, license suspension or revocation, up to $50,000 for repeat violations, and potential restitution to affected parties

Creates a pharmacy benefit manager enforcement fund in the state treasury funded by wholesaler license fees (up to $600 each) and drug pricing fund transfers, with $1.2 million appropriated through June 30, 2027

Authorizes three new full-time positions (attorney, pharmacist, investigator) for enforcement and requires an actuarial analysis of the act's effects on insurance premiums and drug prices; passed House 92-0 and Senate 42-5