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Bill Summary · HB 1114

HB 1114 — Summary (North Dakota)

Status
- Bill number: HB 1114
- Title: Create a new section to chapter 26.1‑36 and amend/reenact N.D.C.C. § 54‑52.1‑04.18 relating to health insurance coverage of insulin drugs and insulin‑related supplies.
- Filed with Secretary of State: 04/03/2025. Introduced: 11/12/2024. (Documented legislative drafting and enrollment materials available.)

Purpose and intent
- To limit out‑of‑pocket costs for people with diabetes by requiring individual and group health benefit plans sold in North Dakota to cover insulin drugs and certain insulin dosing/administration supplies with a hard cap on patient cost sharing for a 30‑day supply. The bill replaces/updates prior statutory language and extends the coverage requirement to plans subject to chapter 26.1‑36.

Key provisions — what the bill would require
- Definitions
- “Insulin drug”: prescription drugs that contain insulin used to treat diabetes mellitus. The statutory list includes rapid‑, short‑, intermediate‑, long‑acting, premixed products (including premixed insulin/GLP‑1 RA), and concentrated human regular insulin.
- “Medical supplies for insulin dosing and administration”: supplies such as blood glucose meters, test strips, lancing devices and lancets, ketone testing supplies, glucagon (injectable and nasal), insulin pen needles, and insulin syringes.
- Explicit exclusions: insulin pumps, electronic insulin‑administering smart pens, continuous glucose monitors (and supplies specifically needed for those devices) are not included in the definitions.
- “Pharmacy or distributor” defined to cover pharmacies and medical supply companies or other distributors filling prescriptions.

  • Coverage requirement

    • Health benefit plans (insurer, nonprofit health service corporation, HMO) may not issue or renew a plan unless it provides benefits for insulin drugs and the listed supplies that comply with this statute.

  • Cost‑sharing limits (per 30‑day supply)

    • Covered insulin drugs: out‑of‑pocket cost may not exceed $25 per pharmacy or distributor, regardless of quantity or insulin type dispensed.
    • Covered insulin dosing/administration supplies: combined out‑of‑pocket cost may not exceed $25 per pharmacy or distributor, regardless of quantity or manufacturer.
    • Prohibitions:
    • A pharmacy benefits manager (PBM), pharmacy, or distributor may not charge or require collection of amounts exceeding these caps.
    • Plans may not impose a deductible, copayment, coinsurance, or other cost‑sharing that results in out‑of‑pocket costs exceeding those caps.

  • Flexibility and limits

    • The statute does not mandate a particular cost‑sharing model (plans can choose structure so long as the caps are honored).
    • If applying the caps to a high‑deductible qualified health plan would cause it to lose HSA (health savings account) eligibility under IRC §223, the deductible exemption applies: the requirement does not apply to the deductible until the enrollee meets the IRC §223 minimum deductible.
    • The statute does not apply to Medicare Part D prescription drug coverage.

Who is affected
- Beneficiaries/enrollees: People covered under individual and group health benefit plans in North Dakota who use insulin and the specified insulin supplies will face lower, capped out‑of‑pocket costs for a 30‑day supply.
- Health plans and issuers: Insurers, HMOs, and nonprofit health service corporations offering plans in North Dakota must design benefit and cost‑sharing structures to comply.
- Pharmacies, distributors, and PBMs: Prohibited from collecting amounts above the statutory caps; may need to change billing, point‑of‑sale collection practices, and contractual arrangements with plans.
- High‑deductible/HSA plans: The bill contains a safeguard so plan deductibles do not automatically lose HSA qualification; deductible treatment may be delayed until the IRS minimum is met.

Procedural and timeline notes
- The bill creates a new statutory section in chapter 26.1‑36 and amends and reenacts N.D.C.C. § 54‑52.1‑04.18 (previous statute text referenced an expiration). Exact effective date is not specified in the summary materials provided; readers should consult the enrolled/passed bill text for an effective date or emergency clause. The bill, as drafted, explicitly excludes Medicare Part D plans.

Potential impacts (high‑level)
- Immediate reduction in cash costs for insured insulin users at the pharmacy for a 30‑day supply of insulin and basic insulin dosing supplies (caps of $25 each).
- Operational changes and potential administrative costs for insurers, PBMs, pharmacies, and distributors to implement cap compliance and reconcile billing/claims.
- Possible adjustments in plan design or premiums over time as plans absorb or reallocate costs; the bill contains an HSA/HDHP safeguard to avoid inadvertent loss of HSA eligibility.

For full statutory text and the enacted language, consult the bill documents and the North Dakota Century Code updates once the bill is enrolled and published.

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

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