The North Dakota Senate Appropriations Committee convened on March 31, 2025, to discuss the Co-Pay Accumulator Bill, a legislative proposal aimed at assisting patients with rare diseases who face high medication costs. Representative Karen Carls, who has championed the bill since the previous session, emphasized its importance for individuals reliant on expensive medications without generic alternatives. The bill seeks to eliminate the practice of insurance companies imposing co-pay accumulators, which can hinder patients' ability to meet their deductibles.

During the meeting, Carls explained that many patients, particularly those with conditions like hemophilia and cystic fibrosis, struggle to afford their deductibles, which can range from $500 to $10,000. The bill aims to ensure that third-party payments towards these deductibles are recognized by insurance companies, thereby easing the financial burden on patients.

The committee also addressed the fiscal implications of the bill, with Rebecca Frikey, executive director of the Public Employees Retirement System (PERS), providing insights into the fiscal note associated with the legislation. Frikey clarified that the bill's language would require co-payments for certain prescription tiers to count towards out-of-pocket maximums, affecting all PERS members, not just those with high-cost diseases. This broad application raised concerns about the fiscal impact on the state and other participating entities.

Committee members discussed the potential for utilizing the PERS health insurance trust fund, which currently holds approximately $55 million, to offset costs associated with the bill. This fund could help mitigate the financial implications for the general fund during the current biennium.

The meeting concluded with a recognition of the complexities surrounding the bill and its fiscal note, as well as the need for further examination of its potential impacts on both state costs and patient care. The committee's discussions highlighted the ongoing challenges faced by patients with rare diseases and the legislative efforts aimed at providing them with necessary support.