Senate unanimously OKs bill expanding pharmacist prescriptive authority with safety limits

The North Dakota Senate on the special-session floor approved an amended bill to expand pharmacists’ prescriptive authority and permit therapeutic substitution for certain medications while excluding others.

Senator Roark, who led amendment negotiations with the state medical and pharmacy boards, described a package of changes meant to preserve patient safety while increasing timely access to care in rural communities. The amendment requires pharmacists who prescribe to notify a patient’s primary-care provider when known, removes provisions allowing pharmacists to treat “uncomplicated urinary tract infections” from the draft, limits supplies to disposable testing rather than high-cost devices, and clarifies that pharmacists can prescribe devices such as epinephrine auto-injectors in addition to the drugs.

On therapeutic substitution, Roark said negotiators switched from an inclusion list to an exclusion list to address medical concerns. The exclusion list on the floor included antidepressants, antipsychotics, chemotherapy agents, Schedule II controlled substances, biological products and narrow therapeutic index drugs. Roark described the amendment as an outcome of compromise: “While neither side got everything they wanted, we found common ground.”

Senator Castaneda questioned how the bill will define and track whether a pharmacist is “educationally prepared” and competent to prescribe in the identified areas; Roark said the Board of Pharmacy will develop guidelines and protocols and that competency tracking would be a board function. Senator Lee added that professional boards already manage renewal and continuing‑education requirements.

The sponsor said the amended bill modestly improved the state’s score for rural health transformation work and estimated that improvement equates to roughly $3.9 million over a five‑year grant period. The Senate recorded a final roll-call of 46 ayes, 0 nays, 1 absent and declared the bill passed.

The enacted text (as read on the floor) amends chapter 43 and related sections of the North Dakota Century Code to add prescriptive authority and therapeutic-substitution standards for pharmacists, specify excluded drug classes, and repeal an outdated provision regarding approved laboratory tests.