House approves bill requiring third‑party copayment assistance to count toward insurers' out‑of‑pocket totals

The North Dakota House of Representatives passed House Bill 1216 on final consideration, 69‑24, moving a measure that changes how insurers treat third‑party co‑payment assistance for prescription drugs.

Supporters and opponents sparred for more than an hour over whether manufacturer or charitable assistance that reduces a patient’s cost at the pharmacy should also count toward the patient’s insurance deductible and coinsurance. Representative Carls, the bill sponsor on the floor, framed the measure as a fix for patients who were effectively charged twice when insurers declined to credit third‑party assistance toward deductibles. "All payments must count, not some, all," Representative Carls said on the floor.

The House considered an amendment offered on the floor to require co‑payment assistance be applied to a patient’s pharmacy cost but not count toward the plan deductible for other medical care. Representative Koppelman described that amendment as a compromise designed to protect plan design incentives while assuring patients access to costly specialty drugs. "The idea is getting affordable medication at the point of picking it up at your pharmacy," Koppelman said. The amendment was put to a verification vote after a voice call and failed narrowly in the verification count, 46 yays to 47 nays.

After the amendment failed, the House agreed to suspend rules to bring the bill forward for final action. The bill then passed 69‑24. Members who opposed the final bill warned of fiscal consequences to state plans and to plan design, and some urged referral to appropriations because of a fiscal note estimated in debate at about $8 million for covered state plans without a grandfathering provision; supporters countered that the bill addresses a pressing access problem for patients on expensive specialty therapies.

Nut graf: The measure responds to a practice known as co‑pay accumulators, where insurers do not credit third‑party payments (for example manufacturer coupons) toward a patient’s deductible or out‑of‑pocket maximum. Proponents said the bill restores predictable coverage for patients who rely on manufacturer or charitable assistance; opponents warned it could shift costs within insurance pools and increase state and employer costs.

Key points from the floor debate and record: - Committee record: Industry, Business and Labor recommended do‑pass on House Bill 1216 by committee vote (reported on the floor as 12 yeas, 1 nay and 1 absent/not voting). The committee reported the bill would create a new section in chapter 26.1‑36 of the North Dakota Century Code and amend section 26.1‑36.6‑03 related to self‑insurance plans. - Failed amendment (verification vote): 46 yays, 47 nays. The amendment would have prevented third‑party assistance from counting toward non‑pharmacy deductibles and coinsurance. - Motion to suspend the rules to act on the bill immediately carried on the floor after a voice vote. - Final vote on House Bill 1216: 69 yea, 24 nay; bill declared passed.

Discussion vs. decision: The House discussion focused on patient access to high‑cost drugs, insurer plan design and actuarial effects, and the size of the fiscal impact to state and public employer plans. The formal decision was the passage of the bill in the form presented on the floor; the proposed protective amendment failed.

Ending: With passage, the bill moves to the next steps in the legislative process; supporters said it will remove a source of surprise costs for patients on specialty medicines while opponents signaled concern about the bill’s fiscal footprint on state and employer plans.