North Dakota requires pharmacy benefit managers to get licenses

Pharmacy benefit managers must hold a license from the insurance commissioner to operate in North Dakota. The license requirement applies to anyone operating as a pharmacy benefit manager in North Dakota. Applicants must provide information the commissioner requests and show $1 million in financial responsibility. The commissioner sets initial and annual renewal fees, each capped at $10,000. The licensing section takes effect January 1, 2026. A license lasts one year and must be renewed annually.

Pharmacy benefit managers must offer pharmacy contracts that require the pharmacy to opt in and sign. These rules apply to pharmacy benefit manager contracts with pharmacies. A manager may not require a pharmacy to join one contract to join another, or exclude a qualified pharmacy that accepts the contract terms and rates. A pharmacy may leave a manager’s contract by giving at least 90 days’ notice.

The insurance commissioner may penalize pharmacy benefit managers that violate the chapter or its rules. These penalties apply to a pharmacy benefit manager found to have violated the chapter or rules adopted under it. Penalties may include a fine of up to $10,000 per violation, license suspension or revocation, and a civil penalty of up to $50,000 for a second or later violation. The commissioner may require repayment for losses to health plans, pharmacies, or covered people. A manager facing penalties is entitled to a hearing.

The law provides an enforcement fund for the insurance commissioner’s work on pharmacy benefit manager rules. The fund supports enforcement of the pharmacy benefit manager chapter. The Pharmacy Board may put up to $600 from each eligible wholesaler and virtual wholesaler license fee into the fund. The drug pricing fund balance transfers into the fund. Money is available to the commissioner only if the Legislature appropriates it. The fund provision is effective through June 30, 2029. A separate appropriation of up to $1.2 million supports enforcement and an analysis of effects on premiums and drug prices through June 30, 2027.