SB 2402

               Sixty-ninth Legislative Assembly of North Dakota
         In Special Session Commencing Wednesday, January 21, 2026
                                         SENATE BILL NO. 2402
                                        (Legislative Management)
                                         (Joint Policy Committee)
AN ACT to create and enact two new sections to chapter 43-15 and a new subsection to section
     43-48-03 of the North Dakota Century Code, relating to the prescriptive authority of pharmacists
     and therapeutic substitution; to amend and reenact subsection 1 of section 26.1-36.11-01 and
     section 43-15-01 of the North Dakota Century Code, relating to the scope of practice of
     pharmacists; to repeal section 43-15-25.3 of the North Dakota Century Code, relating to
     approved laboratory tests; and to provide an effective date.
BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
   SECTION 1. AMENDMENT. Subsection 1 of section 26.1-36.11-01 of the North Dakota Century
Code is amended and reenacted as follows:
    1.   a.    "Comprehensive medication management" means medication management pursuant to
               a standard of care that ensures each enrollee's medications, both prescription and
               nonprescription, are individually assessed to determine each medication is appropriate
               for the enrollee, effective for the medical condition, and safe, given the comorbidities and
               other medications being taken and able to be taken by the enrollee as intended. Services
               provided in comprehensive medication management are, as follows:
               (1)   Performing or obtaining necessary assessments of the enrollee's health status;
               (2)   Formulating a medication treatment plan;
               (3)   Monitoring and evaluating the enrollee's response to therapy, including safety and
                     effectiveness;
               (4)   Performing a comprehensive medication review to identify, resolve, and prevent
                     medication-related problems, including adverse drug events;
               (5)   Providing verbal or written, or both, counseling, education, and training designed to
                     enhance enrollee understanding and appropriate use of the enrollee's medications;
               (6)   Providing information, support services, and resources designed to enhance
                     enrollee adherence with the enrollee's therapeutic regimens;
               (7)   Coordinating and integrating medication therapy management services within the
                     broader health care management services being provided to the enrollee;
               (8)   Initiating or modifying drug therapy under a collaborative agreement with a
                     practitioner in accordance with section 43-15-31.4;
               (9)   Prescribing medications pursuant to protocols approved by the state board of
                     pharmacy in accordance with subsection 24 of section 43-15-10;
              (10)   Administering medications in accordance with requirements in section 43-15-31.5;
                     and
              (11)   Ordering, performing, and interpreting laboratory tests authorized by section
                     43-15-25.3under chapter 43-15 and North Dakota Administrative Code section
                     61-04-10-06.
                                       S. B. NO. 2402 - PAGE 2
        b.   This subsection may not be construed to expand or modify pharmacist scope of practice.
    SECTION 2. AMENDMENT. Section 43-15-01 of the North Dakota Century Code is amended and
reenacted as follows:
   43-15-01. Definitions.
   In this chapter, unless the context or subject matter otherwise requires:
   1.   "Administration" means the direct application of a drug to the body of a patient. The term
        includes:
        a.   The emergency maintenance of a drug delivery device used in home infusion therapy by
             a qualified home pharmacist if nursing service is not available;
        b.   Immunization and vaccination by injection of an individual who is at least three years of
             age upon an order by a practitioner authorized to prescribe such a drug or by written
             protocol with a physician or nurse practitioner and subsequently reported as a childhood
             immunization and other information if required to the state's immunization information
             system pursuant to section 23-01-05.3;
        c.   Provision of other drugs to an individual who is at least three years of age upon the order
             of a practitioner authorized to prescribe such a drug; and
        d.   Provision of drugs to an individual receiving emergency services in a health care facility
             upon an order or by established written protocol.
   2.   "Automated dispensing system" means a mechanical system that performs operations or
        activities, other than compounding or administration, relative to the storage, packaging,
        counting, labeling, and dispensing of medications and which collects, controls, and monitors
        all transaction information.
   3.   "Board" means the state board of pharmacy.
   4.   "Compounding" means the preparation, mixing, assembling, packaging, or labeling of a drug
        or device:
        a.   As the result of a practitioner's prescription drug order or initiative based on the
             practitioner, patient, and pharmacist relationship in the course of professional practice; or
        b.   For the purpose of, or as an incident to, research, teaching, or chemical analysis and not
             for sale or dispensing.
        Compounding also includes the preparation of drugs or devices in anticipation of prescription
        drug orders based on routine, regularly observed prescribing patterns.
   5.   "Confidential information" means individually identifiable health information maintained by the
        pharmacist in the patient's records or which is communicated to the patient as part of a patient
        counseling.
   6.   "Deliver" or "delivery" means the actual, constructive, or attempted transfer of a drug or device
        from one person to another, whether or not for a consideration.
   7.   "Device" means an instrument, apparatus, implement, machine, contrivance, implant, in vitro
        reagent, or other similar or related article, including any component part or accessory, which is
        required under federal or North Dakota law to be prescribed by a practitioner and dispensed
        by a pharmacist.
                                     S. B. NO. 2402 - PAGE 3
 8.   "Dispense" or "dispensing" means the preparation and delivery of a prescription drug,
      pursuant to a lawful order of a practitioner or a nurse licensed under chapter 43-12.1 who is
      authorized by the practitioner to orally transmit the order that has been reduced to writing in
      the patient's record, in a suitable container appropriately labeled for subsequent administration
      to or use by a patient or other individual entitled to receive the prescription drug.
 9.   "Distribute" means the delivery of a drug other than by dispensing or administering.
10.   "Drug" or "drugs" means:
      a.   Articles recognized as drugs in the official United States pharmacopeia, official national
           formulary, official homeopathic pharmacopeia, other drug compendium, or any
           supplement to any of them;
      b.   Articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of
           disease in man or other animal;
      c.   Articles other than food intended to affect the structure or any function of the body of man
           or other animals; and
      d.   Articles intended for use as a component of any articles specified in subdivision a, b,
           or c.
11.   "Drug regimen review" includes the following activities:
      a.   Evaluation of the prescription drug orders and patient records for:
           (1)   Known allergies;
           (2)   Rational therapy-contraindications;
           (3)   Reasonable dose and route of administration; and
           (4)   Reasonable directions for use.
      b.   Evaluation of the prescription drug orders and patient records for duplication of therapy.
      c.   Evaluation of the prescription drug orders and patient records for interactions:
           (1)   Drug-drug;
           (2)   Drug-food;
           (3)   Drug-disease; and
           (4)   Adverse drug reactions.
      d.   Evaluation of the prescription drug orders and patient records for proper utilization,
           including overutilization or underutilization, and optimum therapeutic outcomes.
12.   "Emergency pharmacy practice" means in the event a pharmacist receives a request for a
      prescription refill and the pharmacist is unable to obtain refill authorization from the prescriber,
      the pharmacist may dispense and bill using a pharmacist national provider identifier a
      one-time emergency refill of up to a thirty-day supply of the prescribed medication, provided
      that:
      a.   The prescription is not for a controlled substance listed in schedule II;
      b.   The pharmaceutical is essential to the maintenance of life or to the continuation of
           therapy;
                                       S. B. NO. 2402 - PAGE 4
         c.   In the pharmacist's professional judgment, the interruption of therapy might reasonably
              produce undesirable health consequences or may cause physical or mental discomfort;
         d.   The pharmacist properly records the dispensing; and
         e.   The dispensing pharmacist notifies the prescriber of the emergency dispensing within a
              reasonable time after the one-time emergency refill dispensing.
   13.   "Labeling" means the process of preparing and affixing of a label to any drug container
         exclusive, however, of the labeling by a manufacturer, packer, or distributor of a
         nonprescription drug or commercially packaged legend drug or device. Any label shall include
         all information required by federal and North Dakota law or regulation.
   14.   "Manufacture" means the production, preparation, propagation, compounding, conversion, or
         processing of a device or a drug, either directly or indirectly by extraction from substances of
         natural origin or independently by means of chemical synthesis or by a combination of
         extraction and chemical synthesis and includes any packaging or repackaging of the
         substances or labeling or relabeling of its container, except that this term does not include the
         preparation or compounding of a drug by an individual for the individual's own use or the
         preparation, compounding, packaging, or labeling of a drug:
         a.   By a pharmacist or practitioner as an incident to dispensing or administering of a drug in
              the course of the person's professional practice; or
         b.   By a practitioner or by the practitioner's authorization under supervision for the purpose
              of or as an incident to research, teaching, or chemical analysis and not for sale.
   15.   "Manufacturer" means a person engaged in the manufacture of drugs in facilities located
         within North Dakota.
   16.   "Medicine" means a drug or combination of drugs, used in treating disease in man or other
         animals.
   17.   "Nonprescription drugs" means medicines or drugs which may be sold without a prescription
         and which are prepackaged for use by the consumer and labeled in accordance with the
         requirements of the statutes and regulations of this state and the federal government.
   18.   "Original package" means the original carton, case, can, box, vial, bottle, or other receptacle,
         put up by the manufacturer or wholesaler or distributor, with label attached, making one
         complete package of the drug article.
   19.   "Patient-pharmacist relationship" means the required relationship between a patient and a
         pharmacist as defined under the rules of the board which authorizes the pharmacist to
         independently prescribe drugs, drug categories, and devices as limited by this chapter.
   20.   "Person" means an individual, corporation, limited liability company, partnership, association,
         or any other legal entity.
20.21.   "Pharmaceutical care" is the provision of drug therapy and other pharmaceutical patient care
         services intended to achieve outcomes related to the cure or prevention of a disease,
         elimination or reduction of a patient's symptoms, or arresting or slowing of a disease process
         as defined in the rules of the board.
21.22.   "Pharmacist" means a person to whom the board has issued a license to practice the
         profession of pharmacy whose license has not expired or been suspended.
22.23.   "Pharmacy" or "drugstore" means every store or shop where drugs, medicines, or chemicals
         are dispensed, displayed for sale, or sold, at retail for medicinal purposes, or where
         prescriptions are compounded, and which is duly registered by the board.
                                        S. B. NO. 2402 - PAGE 5
23.24.   "Pharmacy technician" means a person registered by the board who is employed by a
         pharmacy to assist licensed pharmacists in the practice of pharmacy by performing specific
         tasks delegated by and under the immediate personal supervision and control of a licensed
         pharmacist, as permitted by the board.
24.25.   "Practice of pharmacy" means the:
         a.   The interpretation, evaluation, and monitoring of prescription orders and patient drug
              therapy; the
         b.   The compounding, dispensing, and labeling of drugs and devices except labeling by a
              manufacturer, packer, or distributor of nonprescription drugs and commercially packaged
              legend drugs and devices; the
         c.   The participation in drug selection, drug monitoring, drug administration, drug regimen
              review, the provision of these acts or services necessary as a primary health care
              provider of pharmaceutical care, and drug utilization evaluations; the
         d.   The proper and safe storage of drugs and devices and the maintenance of proper
              records for this storage; the
         e.   The responsibility for advising, consulting, and educating if necessary or if regulated,
              patients, the public, and other health care providers on the rational, safe, and
              cost-effective use of drugs including therapeutic values, content, hazards, and
              appropriate use of drugs and devices; the
         f.   The participation in interpreting and applying pharmacokinetic data and other pertinent
              laboratory data to design safe and effective drug dosage regimens; if
         g.   If appropriate and if regulated, the participation in scientific or clinical drug research
              either scientific or clinical as an investigator or in collaboration with other investigators for
              the purposes of studying the effects of drugs on animals or human subjects, with other
              drugs or chemicals, and with drug delivery devices; emergency
         h.   Emergency pharmacy practice; prescriptive
         i.   Prescriptive practices as limited under this chapter; the
         j.   The ordering of laboratory tests;
         k.   The performance of laboratory tests to provide pharmaceutical care services which are
              waived under the Federal Clinical Laboratory Improvement Act of 1988 [Pub. L. 100-578,
              section 2; 102 Stat. 2903; 42 U.S.C. 263a et seq.], as amended; and the
         l.   The offering or performing of those acts, services, operations, or transactions necessary
              in the conduct, operation, management, and control of pharmacy.
25.26.   "Practitioner" means an individual licensed, registered, or otherwise authorized by the
         jurisdiction in which the individual is practicing to prescribe drugs in the course of professional
         practice.
26.27.   "Prescription" means any order for drugs or medical supplies, if such order is written or signed
         or transmitted by word of mouth, telephone, telegram, or other means of communication by a
         duly licensed physician, optometrist, dentist, veterinarian, or other practitioner, licensed by law
         to prescribe and administer such drugs or medical supplies intended to be filled, compounded,
         or dispensed by a pharmacist or any order for drugs or medical supplies transmitted orally by
         a nurse licensed under chapter 43-12.1 as written and signed by such a duly licensed
         physician, optometrist, dentist, veterinarian, or other practitioner.
                                         S. B. NO. 2402 - PAGE 6
27.28.   "Prescription drug or legend drug" means a drug which, under federal law is required, prior to
         being dispensed or delivered, to be labeled with one of the following:
         a.   "Caution: Federal law prohibits dispensing without prescription";
         b.   "Caution: Federal law restricts this drug to use by or on the order of a licensed
              veterinarian"; or
         c.   Rx only;
         or a drug which is required by any applicable federal or North Dakota law or rule to be
         dispensed on prescription only or is restricted to use by practitioners only.
28.29.   "Public health issues" include immunizations, tobacco cessation, and other issues deemed
         appropriate by the board.
29.30.   "Radiopharmaceutical service" means, but is not limited to, the compounding, dispensing,
         labeling, and delivery of radiopharmaceuticals; the participation in radiopharmaceutical
         selection and radiopharmaceutical utilization reviews; the proper and safe storage and
         distribution of radiopharmaceuticals; the maintenance of radiopharmaceutical quality
         assurance; the responsibility for advising, where necessary or where regulated, of therapeutic
         values, hazards, and use of radiopharmaceuticals; and the offering or performing of those
         acts, services, operations, or transactions necessary in the conduct, operation, management,
         and control of radiopharmaceuticals.
30.31.   "Wholesaler" means a person with facilities located in this state who buys for resale and
         distribution to persons other than consumers.
   SECTION 3. A new section to chapter 43-15 of the North Dakota Century Code is created and
enacted as follows:
   Prescriptive authority.
    1.   A pharmacist whose practice is physically located within this state, acting in good faith and
         exercising reasonable care, may independently prescribe drugs, drug categories, and devices
         as provided in this section if each of the following requirements are met:
         a.   A pharmacist may prescribe drugs or devices only for conditions for which the pharmacist
              is educationally prepared and competence has been achieved and maintained.
         b.   A pharmacist may issue a prescription only for a legitimate medical purpose arising from
              a patient-pharmacist relationship.
         c.   A pharmacist shall obtain adequate information about the patient's health status to make
              appropriate decisions based on the applicable standard of care.
         d.   For each drug or drug category a pharmacist intends to prescribe, the pharmacist shall
              maintain a patient assessment protocol based on current clinical guidelines, when
              available, or evidence-based research findings that specify the following:
              (1)   Patient inclusion and exclusion criteria; and
              (2)   Explicit medical referral criteria.
         e.   A pharmacist shall revise the patient assessment protocol when necessary to ensure
              continued compliance with clinical guidelines or evidence-based research findings. The
              pharmacist's patient assessment protocol, and any related forms, must be made
              available to the board upon request.
                                   S. B. NO. 2402 - PAGE 7
     f.   A pharmacist shall consult with and refer to other health care professionals as
          appropriate, including in situations where the pharmacist's knowledge or experience is
          limited.
     g.   A pharmacist shall develop and implement an appropriate follow-up care plan, including
          any monitoring parameters, in accordance with clinical guidelines. The plan may include
          follow-up care with the patient and communication with the patient's primary care
          provider.
     h.   A pharmacist shall inquire about the identity of the patient's primary care provider or
          provider of record. If a primary care provider or provider of record is identified, the
          pharmacist shall provide notification to the primary care provider or provider of record
          within three business days following the prescription of a drug. The notification must
          include the results of any test that required the prescription and, upon the provider's
          request, any relevant documentation required under subdivision i.
     i.   A pharmacist shall maintain documentation adequate to justify the care provided,
          including information collected as part of the patient assessment, the prescription record,
          any notification provided under this section, and the follow-up care plan.
2.   A pharmacist may prescribe any drug approved by the federal food and drug administration
     which is indicated for the following conditions:
     a.   Lice;
     b.   Cold sores;
     c.   Motion sickness, including the prevention of motion sickness; and
     d.   Hypoglycemia.
3.   A pharmacist may prescribe any of the following devices approved by the federal food and
     drug administration:
     a.   Inhalation spacer;
     b.   Nebulizer;
     c.   Disposable diabetes blood sugar testing supplies;
     d.   Pen needles; and
     e.   Auto-injectors containing drugs for patients with a documented history of allergies or
          anaphylaxis.
4.   A pharmacist may prescribe any drug approved by the federal food and drug administration
     which is indicated for the following conditions, provided the symptomatic patient first tests
     positive to a test that is waived under the Federal Clinical Laboratory Improvement Act of 1988
     [Pub. L. 100-578, section 2; 102 Stat. 2903; 42 U.S.C. 263a et seq.], as amended:
     a.   Influenza;
     b.   Group A streptococcal pharyngitis; and
     c.   Severe acute respiratory syndrome coronavirus 2 identified as SARS-CoV-2.
5.   If a patient tested positive for influenza, a pharmacist may prescribe an antiviral drug to an
     individual who has been exposed to the infected patient and for whom the clinical guidelines
     recommend chemoprophylaxis.
                                       S. B. NO. 2402 - PAGE 8
   6.   A pharmacist may prescribe any drug approved by the federal food and drug administration for
        the purpose of closing a gap in clinical guidelines as follows:
        a.   Postexposure prophylaxis for nonoccupational exposure to human immunodeficiency
             virus infection; and
        b.   Short-acting beta agonists for a patient with asthma who has had a prior prescription for
             a short-acting beta agonist and who has a current prescription for a long-term asthma
             control drug.
   7.   A pharmacist who successfully completes an accredited continuing pharmacy education or
        continuing medical education course on travel medicine may prescribe any noncontrolled drug
        recommended for individuals traveling outside the United States which is specifically listed in
        the federal centers for disease control and prevention health information for international travel
        publication. The pharmacist only may prescribe drugs that are indicated for the patient's
        intended destination for travel.
   8.   If an emergency situation exists which in the professional judgment of the pharmacist
        threatens the health or safety of the patient, a pharmacist may prescribe the following drugs
        approved by the federal food and drug administration in the minimum quantity necessary until
        the patient is able to be seen by a provider:
        a.   Diphenhydramine;
        b.   Epinephrine; and
        c.   Short-acting beta agonists.
   9.   A pharmacist may prescribe antimicrobial prophylaxis for the prevention of lyme disease in
        accordance with the federal centers for disease control and prevention guidelines.
   SECTION 4. A new section to chapter 43-15 of the North Dakota Century Code is created and
enacted as follows:
   Therapeutic substitution.
   1.   A pharmacist whose practice is physically located within this state may substitute a drug for a
        therapeutically equivalent drug, except for antidepressants, antipsychotics, chemotherapy
        agents, schedule II controlled substances, biological products, and narrow therapeutic index
        drugs, as limited by this section. Therapeutic equivalence may be established by clinical
        publications comparing dosages of drugs in a therapeutic class.
   2.   A pharmacist may not substitute a drug for a therapeutically equivalent drug if:
        a.   The prescriber indicates no substitution is to be made; or
        b.   The board has determined a therapeutically equivalent drug should not be substituted
             and notified pharmacists of that determination.
   3.   Before dispensing a therapeutically equivalent drug, a pharmacist shall:
        a.   Verbally discuss the suggested substitution with the patient, including informing the
             patient that the therapeutically equivalent drug does not contain the identical active
             ingredient present in the prescribed drug and any differences in dosage and frequency
             between the prescribed drug and the therapeutically equivalent drug;
        b.   Inform the patient of the patient's right to refuse the substitution; and
                                      S. B. NO. 2402 - PAGE 9
         c.   Determine whether the substitution would provide a cost benefit to the patient or provide
              access if the prescribed drug is not available.
    4.   The pharmacist shall send notice of the substitution to the prescriber by electronic
         communication within twenty-four hours of dispensing the drug to the patient.
    5.   The prescribing provider is not liable for a substitution made by a pharmacist under this
         section.
    SECTION 5. A new subsection to section 43-48-03 of the North Dakota Century Code is created
and enacted as follows:
         Pharmacists duly and currently licensed to practice pharmacy.
   SECTION 6. REPEAL. Section 43-15-25.3 of the North Dakota Century Code is repealed.
    SECTION 7. EFFECTIVE DATE. This Act becomes effective upon its filing with the secretary of
state.
                                        S. B. NO. 2402 - PAGE 10
                        ____________________________  ____________________________
                        President of the Senate  Speaker of the House
                        ____________________________  ____________________________
                        Secretary of the Senate  Chief Clerk of the House
This certifies that the within bill originated in the Senate of the Sixty-ninth Legislative Assembly of North
Dakota and is known on the records of that body as Senate Bill No. 2402.
Senate Vote:      Yeas 46  Nays 0  Absent 1
House Vote:       Yeas 91  Nays 1  Absent 2
                                                                      ____________________________
                                                                      Secretary of the Senate
Received by the Governor at ________M. on _____________________________________, 2026.
Approved at ________M. on __________________________________________________, 2026.
                                                                      ____________________________
                                                                      Governor
Filed in this office this ___________day of _______________________________________, 2026,
at ________ o’clock ________M.
                                                                      ____________________________
                                                                      Secretary of State