Four axes from current statute and agency guidance. Teal bar = substitution/assistance/access in place; amber = permissive or absent.
| Generic substitution mandate | Permissive |
| State Pharmaceutical Assistance Program | No broad SPAP |
| 90-day fills permitted | Allowed |
| PMP mandatory prescriber query | Required by statute |
North Dakota permits but does not mandate generic substitution. Under N.D.C.C. § 43-15-31.4, a pharmacist may substitute a less expensive equivalent drug product unless the prescriber has indicated "dispense as written." The substitute must be FDA AB-rated.
The North Dakota Department of Health and Human Services administers ND Medicaid pharmacy benefits and maintains the ND Medicaid PDL. ND Medicaid runs primarily as fee-for-service. Non-preferred drugs require prior authorization.
Preferred Drug List: View current PDL
Prior authorization contact: North Dakota Medicaid Pharmacy: 1-877-328-7098
North Dakota does not operate a Medicare-recognized SPAP. Low-income North Dakotans use Medicare Part D Extra Help (LIS), North Dakota Medicaid (if eligible), manufacturer Patient Assistance Programs, and SHIC (Senior Health Insurance Counseling) for Medicare enrollment counseling.
Eligibility: No state SPAP. SHIC (Senior Health Insurance Counseling) helps with Medicare enrollment.
North Dakota permits 90-day fills of non-controlled chronic medications. Out-of-state pharmacies must hold a North Dakota Nonresident Pharmacy permit. Federal CSA refill limits apply.
North Dakota operates a Prescription Drug Monitoring Program administered by the Board of Pharmacy. Prescribers must check the PDMP before initially prescribing certain controlled substances under N.D.C.C. § 19-03.5-01 et seq. Dispensers must report Schedule II-V dispensing within one business day.
PMP portal: North Dakota Prescription Drug Monitoring Program (PDMP)
North Dakota hosts a 340B network including Sanford Health, Essentia Health, Altru Health, FQHCs across Fargo/Bismarck/rural counties, and Indian Health Service facilities serving multiple reservations.
Find a 340B clinic in North Dakota: HRSA OPAIS database (ND filter)
Our sister site OmniRx maintains a federal-side patient assistance program directory covering manufacturer PAPs, foundation copay assistance, GoodRx-style discount cards, and 340B locators applicable nationwide.
Once the law side is clear, the next question is which pharmacy actually has the cheapest fill. Use the RxGrab Pharmacy Finder to compare CostPlus Drugs, Costco, Walmart, Amazon Pharmacy, and other discount pharmacies on your specific medication, and read our generic vs brand explainer for the bioequivalence rules behind every substitution.
Yes unless your prescriber wrote "dispense as written." Under N.D.C.C. § 43-15-31.4 substitution is permissive.
No. Use federal Extra Help, North Dakota Medicaid if eligible, and manufacturer Patient Assistance Programs.
Most pharmacy benefits run as fee-for-service with a unified ND Medicaid PDL. Non-preferred drugs need prior auth from your prescriber.
Yes for certain controlled-substance prescriptions under N.D.C.C. § 19-03.5-01 et seq.