Representative Koppelman described a further amendment to House Bill 1216 intended to preserve patients’ use of third-party cost-sharing assistance while preventing insurers from counting those third-party payments toward deductibles or maximum out-of-pocket calculations.

Koppelman said the amendment would insert clarifying language so contributions made by a cost-sharing assistance program are “not calculated as part of the enrollee’s deductible or maximum out of pocket” while still allowing the assistance to reduce the amount a patient pays at the pharmacy counter. He also proposed that enrollees notify the health plan of any cost-sharing assistance used to reduce co-payments.

Representative Carls, identified as the bill sponsor, said the amendment “pretty much negates the bill” because his original proposal would have required insurers to count third-party payments toward deductibles. Carls told the committee patients “navigate years of misdiagnosis” and face high cost-sharing for specialty and rare drugs; he said 19 states have banned copay accumulator practices and argued North Dakota should do the same.

Committee members debated practical implications, including whether manufacturers and foundations permit ongoing assistance throughout the plan year or concentrate payments early in the year to meet deductibles. Representative Casper said the amendment was a compromise that would allow immediate at-the-counter assistance without shifting deductible costs onto other members, and Representative Shower moved a “do pass” on the bill as further amended. Representative Casper seconded the motion.

The committee held a roll-call vote on the motion to recommend House Bill 1216 as further amended. The roll call recorded a majority in favor and one dissenting vote (Representative Ruby). The committee also discussed related PBM (pharmacy benefit manager) transparency and future bills targeting PBM practices; members said additional PBM legislation remains under consideration.

Ending: The committee recommended House Bill 1216 “do pass” as further amended and identified Representative Koppelman as the likely floor carrier. Members said PBM and drug-manufacturer oversight bills remain on the committee’s future calendar.