The bill amends Minnesota Statutes 2022, section 256B.0625, subdivision 13e, to modify the definition of "usual and customary price" for medical assistance prescription drug reimbursement. The new definition specifies that the usual and customary price is the lowest price charged by the provider to a patient paying with cash, check, or charge account, and it includes prices charged to patients enrolled in pharmacy-administered prescription savings or discount clubs, with the exception of clubs where individuals pay to access special rates or discounts. Additionally, the bill mandates that the submitted charge must reflect all discount amounts applied by any third-party provider or insurer agreement, ensuring that the net submitted charge does not exceed the patient liability for the service.

Furthermore, the bill outlines various payment rates and reimbursement structures for pharmacies, including professional dispensing fees and ingredient cost calculations based on the National Average Drug Acquisition Cost (NADAC) or wholesale acquisition cost. It also establishes provisions for pharmacies using automated drug distribution systems and packaging systems for long-term care facilities, allowing for retrospective billing and requiring credits for unused drugs eligible for reuse. The commissioner is granted authority to conduct a cost of dispensing survey for pharmacies and to adjust reimbursement rates as necessary, ensuring that the reimbursement system remains responsive to the needs of both pharmacies and patients.

Statutes affected:
Introduction: 256B.0625