North Dakota Code § 43-15-31.7

Therapeutic substitution
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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
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.

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