Pharmacists for Fair Reimbursement What your state's PBM laws actually mean for community pharmacies
State Tracker Updated June 15, 2026

North Dakota: what the PBM reimbursement law requires

North Dakota requires MAC-list transparency, bars setting MAC prices below the PBM's own pricing sources, excludes dispensing fees from the MAC calculation, and guarantees a MAC appeal answered within 7 business days. It does not impose a NADAC-plus-fee reimbursement floor, and the MAC rules do not apply to Medicaid.

Status Partially enacted
Law N.D.C.C. § 19-02.1-14.2 (MAC list and appeals); PBM licensure overhaul, HB 1584 (2025)
Effective date MAC statute in effect; HB 1584 effective April 29, 2025 (licensing provision January 1, 2026)
Reimbursement basis No acquisition-cost or NADAC floor; MAC prices may not be set below the PBM's own pricing sources, and dispensing fees are excluded from the MAC calculation
Professional dispensing fee Not specified in statute (only required to be excluded from the MAC calculation)
Appeal route PBM must provide a reasonable appeals procedure and issue a determination within 7 business days, applied to all similarly situated in-network pharmacies

North Dakota has a strong MAC-transparency and PBM-licensure regime but not a reimbursement floor. Under N.D.C.C. § 19-02.1-14.2, a PBM may not set MAC prices below its own pricing sources and may not fold dispensing fees into the MAC calculation, and it must answer a MAC appeal within 7 business days, applied to all similarly situated network pharmacies. The MAC rules do not apply to the state Medicaid program.

The 2025 PBM licensure overhaul (HB 1584), enacted as an emergency measure, adds licensing and enforcement but does not create an acquisition-cost or NADAC floor.

Sources

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