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SB 2248

A BILL for an Act to amend and reenact section 19-02.1-16.3 of the North Dakota Century Code, relating to step therapy protocols; to provide for a report to the legislative assembly; to provide for application; and to provide an expiration date.

69th Legislative Assembly (2025-26) Introduced by Jeff Barta and 5 co-sponsors

Prohibits step therapy for metastatic cancer drugs when FDA-approved or peer-reviewed supported, for state group insurance through 2027, with a PERS impact report.

Second reading, failed to pass, yeas 2 nays 45
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Bill Summary · SB 2248

Summary — SB 2248 (North Dakota)

A bill to amend and reenact section 19-02.1-16.3 of the North Dakota Century Code to limit step therapy requirements for certain metastatic cancer treatments, require a report to the Legislative Assembly, specify applicability to the state group insurance program, and set an expiration date.

Main purpose and intent

To prevent pharmacy benefit managers (PBMs) and health plans from imposing step therapy (fail-first) protocols when a prescribing health care practitioner recommends a drug (or drug sequence) to treat metastatic cancer or an associated condition — provided the drug is FDA‑approved for the indication or its use is supported by peer‑reviewed medical literature. The measure is temporary and requires the Public Employees Retirement System (PERS) to report on program impacts and recommend whether the change should be continued.

Key provisions

  • Definitions:
    • "Metastatic cancer" — cancer that has spread beyond the primary site.
    • "Associated condition" — a symptom or side effect linked to metastatic cancer or its treatment that, in the practitioner’s judgment, would further jeopardize health if untreated.
    • "Step therapy protocol" — a protocol requiring use of one or more drugs other than the provider‑recommended drug(s) before covering the recommended drug(s).
  • Prohibition on step therapy:
    • PBMs and health plans may not require step therapy for a provider‑recommended prescription drug (or sequence) when:
    • It is prescribed to treat metastatic cancer or an associated condition; and
    • Its use is consistent with FDA‑approved indications or supported by peer‑reviewed medical literature.
  • Reporting and legislative review:
    • PERS must prepare and submit a bill to the next (seventieth) Legislative Assembly to repeal the act’s expiration date and must append a report documenting the effect of the policy on the system’s health insurance programs — including utilization, costs, and a recommendation on continuation.
  • Application and duration:
    • Applies to coverage provided by the uniform group insurance program under chapter 54‑52.1 that begins after June 30, 2025 and does not extend past June 30, 2027.
    • The Act is effective through June 30, 2027; it lapses after that date unless the Legislature acts.

Who is affected

  • Directly: patients with metastatic cancer and associated conditions covered under the state’s uniform group insurance program; prescribing health care practitioners; PBMs and health plans that administer or underwrite state group coverage.
  • Indirectly: employers and beneficiaries in the state group program (potential premium/cost impacts); PERS (responsible for reporting).

Potential impacts and considerations

  • Access: Likely improves timely access to provider‑recommended cancer therapies for affected state employees and dependents by removing a common administrative hurdle.
  • Cost: Could increase pharmaceutical spending for the state group insurance program if lower‑cost alternatives are bypassed; PERS report is required to quantify utilization/cost effects.
  • Scope/Limitations: The prohibition is limited to metastatic cancer and associated conditions and to coverage under the state uniform group insurance program for a defined period (through 6/30/2027). It does not mandate coverage of non‑formulary drugs.
  • Legislative follow‑up: Continuation beyond 2027 requires legislative action informed by the PERS report.

Procedural/timeline notes

  • The bill text amends NDCC §19‑02.1‑16.3 and sets an explicit expiration date of June 30, 2027.
  • PERS must submit a draft bill and supporting report to the seventieth Legislative Assembly to consider removing the expiration and extending the requirement to broader market policies.

(Prepared from the introduced text of SB 2248 as provided.)

Compiled from official sources — confirm details with the bill’s official record.

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