For the purposes of this chapter, unless the context otherwise requires: 1. a. "Comprehensive medication management" means medication management pursuant to a standard of care that ensures each enrollee's medications, both prescription and nonprescription, are individually assessed to determine each medication is appropriate for the enrollee, effective for the medical condition, and safe, given the comorbidities and other medications being taken and able to be taken by the enrollee as intended. Services provided in comprehensive medication management are, as follows: (1) Performing or obtaining necessary assessments of the enrollee's health status; (2) Formulating a medication treatment plan; (3) Monitoring and evaluating the enrollee's response to therapy, including safety and effectiveness; (4) Performing a comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events; (5) Providing verbal or written, or both, counseling, education, and training designed to enhance enrollee understanding and appropriate use of the enrollee's medications; (6) Providing information, support services, and resources designed to enhance enrollee adherence with the enrollee's therapeutic regimens; (7) Coordinating and integrating medication therapy management services within the broader health care management services being provided to the enrollee; (8) Initiating or modifying drug therapy under a collaborative agreement with a practitioner in accordance with section 43-15-31.4; (9) Prescribing medications pursuant to protocols approved by the state board of pharmacy in accordance with subsection 24 of section 43-15-10; (10) Administering medications in accordance with requirements in section 43-15-31.5; and (11) Ordering, performing, and interpreting laboratory tests authorized under chapter 43-15 and North Dakota Administrative Code section 61-04-10-06. b. This subsection may not be construed to expand or modify pharmacist scope of practice. 2. "Enrollee" means an individual covered under a health benefit plan. 3. "Health benefit plan" has the same meaning as provided in section 26.1-36.3-01, whether offered on a group or individual basis. 4. "Health carrier" or "carrier" has the same meaning as provided in section 26.1-36.3-01.
26.1-36.11-02. Required coverage for comprehensive medication management services. 1. A health carrier shall provide coverage for licensed pharmacists to provide comprehensive medication management to eligible enrollees who elect to participate in a comprehensive medication management program. 2. At least annually, the health carrier shall provide, in print, or electronically under the provisions of section 26.1-02-32, notice of an enrollee's eligibility to receive comprehensive medication management services from a pharmacist, delivered to the eligible enrollee and the enrollee's designated primary care provider, if applicable, and if at least one of the following criteria are met: a. The enrollee is taking five or more chronic medications; b. The enrollee was admitted to a hospital with one of the following diagnoses: (1) Heart failure; (2) Pneumonia;
(3) Myocardial infarction; (4) Mood disorder; or (5) Chronic obstructive pulmonary disorder; or c. The enrollee has active diagnosis of comorbid diabetes and: (1) Hypertension; or (2) Hyperlipemia. 3. Comprehensive medication management services may be provided via telehealth as defined in section 26.1-36-09.15 and may be delivered into an enrollee's residence. 4. The health carrier shall include an adequate number of pharmacists in the carrier's network of participating pharmacy providers. a. The participation of pharmacists and pharmacies in the health carrier network's or health carrier's affiliate network's drug benefit does not satisfy the requirement that health benefit plans include pharmacists in the health benefit plan's networks of participating pharmacy providers. b. For health benefit plans issued or renewed after December 31, 2024, health carriers that delegate credentialing agreements to contracted health care facilities shall accept credentialing for pharmacists employed or contracted by those facilities. Health carriers shall reimburse facilities for covered services provided by network pharmacists within the pharmacists' scope of practice per negotiations with the facility. 5. The health carrier shall post electronically a current and accurate directory of pharmacists who are participating pharmacy providers and eligible to provide comprehensive medication management. a. In making the directory available electronically, the health carrier shall ensure the general public is able to view all of the current providers for a plan through a clearly identifiable link or tab and without creating or accessing an account or entering a policy or contract. b. The health carrier shall ensure that one hundred percent of provider directory entries are audited annually for accuracy and retain documentation of the audit to be made available to the commissioner upon request. c. The health carrier shall provide a print copy of current electronic directory information upon request of an enrollee or a prospective enrollee. d. The electronically posted directory must include search functionality that enables electronic searches by each of the following: (1) Name; (2) Participating location; (3) Participating facility affiliations, if applicable; (4) Languages spoken other than English, if applicable; and (5) Whether accepting new enrollees. 6. The requirements of this section apply to all health benefit plans issued or renewed after December 31, 2024.