North Dakota

North Dakota passed Senate Bill 2102 on 04/24/2019 and it was signed by the governor on 04/23/2019. This law created Chapter 26.1-53.1 of the North Dakota Century Code and included a lengthy twelve page discussion of direct primary care and discount plans. Great laws such as those in Wyoming and Kentucky are limited to one page.

DPC was defined as not a “discount plan” which is another type of regulated plan product in North Dakota. The phrase direct primary care is only listed twice on page one, and appears no where else in the twelve page document.

“Direct primary care means any private contract between a provider and consumer for services associated with that provider.” This is not a harmful definition, but it is broad and vague, potentially leading to confusion if litigated.

“Discount plan means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration, offers members the access to providers of medical or ancillary services and the right to receive discounts on medical or ancillary services provided under the discount plan from those providers. The term includes a discount prescription drug plan. The term does not include:

a. A plan that does not charge a membership, payment, dues, other consideration, or other fee to use the discount plan;
b. Any product otherwise regulated under title 26.1 ;
c. Direct primary care;
d. A patient access program; or
e. A Medicare prescription drug plan.”

Be sure to review the North Dakota Insurance Code when planning your DPC practice.

In 2015 Mark J Hardy, Pharm D, Executive Director of the ND State Board of Pharmacy published this helpful Administrative Guidelines for Practitioner Dispensing in North Dakota. Here is the most important language:

“Physicians are exempt from the pharmacy practice statutory requirements under North Dakota Century Code (NDCC) 43-15-02”. Exemptions - “A duly licensed practitioner of medicine supplying the practitioner's own patients with such remedies as the practitioner may desire.” And North Dakota Administrative Code (NDAC) 61-04-02-01

– The exemption contained in subsection 1 of NDCC 43-15-02 for a duly licensed practitioner of medicine supplying the practitioner’s own patients with such remedies as the practitioner may desire shall exempt such practitioners who dispense remedies as an incident to the practice of their profession for a patient’s immediate needs, which would be those drugs required for a seventy-two hour time period, full course of antibiotic treatment, starter pack of pre-packaged medications, or up to a ten day supply of initial therapy of maintenance medication that should be started immediately, but shall not exempt such a practitioner who regularly engages in dispensing such remedies to the practitioner’s patients for which such patients are charged either separately or together with charges for other professional services, from recordkeeping, dispensing, labeling, counseling as required by NDCC 43-15-31.2, patient profile system as required by NDCC 43-15-31.1, and all other requirements of the practice of pharmacy as set forth in this chapter or by federal and state laws as they pertain to the regulation of practice of pharmacy. Documented charts shall meet the requirements of the patient profile system.”