A bill for an act
relating to health care; modifying pharmacy benefit manager business practices;
establishing pharmacy benefit manager general reimbursement practices; modifying
maximum allowable cost pricing requirements; amending Minnesota Statutes 2022,
sections 62W.02, by adding subdivisions; 62W.04; 62W.08; 62W.13; proposing
coding for new law in Minnesota Statutes, chapter 62W.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Minnesota Statutes 2022, section 62W.02, is amended by adding a subdivision
to read:
new text begin
"Pharmacy acquisition cost" means the amount
that a pharmaceutical wholesaler charges for a pharmaceutical product as listed on the
pharmacy's invoice.
new text end
Minnesota Statutes 2022, section 62W.02, is amended by adding a subdivision to
read:
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"Pharmaceutical wholesaler" means a person
that sells and distributes prescription pharmaceutical products, including but not limited to
brand name, generic, and over-the-counter drugs, and offers regular and private delivery to
a pharmacy.
new text end
Minnesota Statutes 2022, section 62W.02, is amended by adding a subdivision to
read:
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"Spread pricing" means a model of prescription drug pricing
in which the pharmacy benefit manager charges a plan sponsor a contracted price for
prescription drugs, and the contracted price for the prescription drugs differs from the amount
the pharmacy benefit manager directly or indirectly pays the pharmacy for the prescription
drugs.
new text end
Minnesota Statutes 2022, section 62W.04, is amended to read:
(a) A pharmacy benefit manager must exercise good faith and fair dealing in the
performance of its contractual duties. A provision in a contract between a pharmacy benefit
manager and a health carrier or a network pharmacy that attempts to waive or limit this
obligation is void.
(b) A pharmacy benefit manager must notify a health carrier in writing of any activity,
policy, or practice of the pharmacy benefit manager that directly or indirectly presents a
conflict of interest with the duties imposed in this section.
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(c) A pharmacy benefit manager must not cause or knowingly permit the use of
advertisement, promotion, solicitation, representation, proposal, or offer that is untrue,
deceptive, or misleading.
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(d) A pharmacy benefit manager must not charge a pharmacy a fee related to the
adjudication of a claim, including but not limited to:
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(1) the receipt and processing of a pharmacy claim;
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(2) the development or management of claims processing services in a pharmacy benefit
manger network; or
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(3) participation in a pharmacy benefit network.
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(e) A pharmacy benefit manager must not require pharmacy accreditation standards or
certification requirements that are inconsistent with, more stringent than, or in addition to
requirements established by the board of pharmacy or as permitted under this chapter.
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(a) A pharmacy benefit manager must not reimburse a pharmacy in an amount less than
the amount the pharmacy benefit manger reimburses a pharmacy benefit manager affiliate
or subsidiary for providing the same prescription drug. The amount must be calculated on
a per unit basis using the same generic product identifier or generic code number.
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(b) A pharmacy benefit manager must not pay or reimburse a pharmacy for the ingredient
drug product component less than the national average drug acquisition cost or, if the national
drug acquisition cost is unavailable, the wholesale acquisition cost.
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(c) A pharmacy benefit manager must not make or permit any reduction of payment for
a prescription drug or service either directly or indirectly to a pharmacy under a reconciliation
process to an effective rate of reimbursement, direct or indirect remuneration fees, or any
other reduction or aggregate reduction of payment.
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(d) A pharmacy benefit manager is prohibited from conducting spread pricing.
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(e) Termination of a pharmacy from the pharmacy benefit manager network does not
release the pharmacy benefit manager from the obligation to make any payment due to the
pharmacy for drugs or services rendered.
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Minnesota Statutes 2022, section 62W.08, is amended to read:
(a) With respect to each contract and contract renewal between a pharmacy benefit
manager and a pharmacy, the pharmacy benefits manager must:
(1) provide to the pharmacy, at the beginning of each contract and contract renewal, the
sources utilized to determine the maximum allowable cost pricing of the pharmacy benefit
manager;
(2) update any maximum allowable cost price list at least every seven business days,
noting any price changes from the previous list, and new text begin within seven calendar days from:
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(i) an increase of ten percent or more in the pharmacy acquisition cost from 60 percent
or more of the pharmaceutical wholesalers doing business in the state;
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(ii) a change in the methodology on which the maximum allowable cost price list is
based; or
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(iii) a change in the value of a variable involved in the methodology;
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new text begin (3) new text end provide a means by which network pharmacies may promptly review current prices
in an electronic, print, or telephonic format within one business day at no cost to the
pharmacy;
deleted text begin (3)deleted text end new text begin (4)new text end maintain a procedure to eliminate products from the list of drugs subject to
maximum allowable cost pricing in a timely manner in order to remain consistent with
changes in the marketplace;
deleted text begin (4)deleted text end new text begin (5)new text end ensure that the maximum allowable cost prices are not set below sources utilized
by the pharmacy benefits managernew text begin nor set below the pharmacy acquisition costnew text end ; and
deleted text begin (5)deleted text end new text begin (6)new text end upon request of a network pharmacy, new text begin identify each maximum allowable price
list that applies to the network pharmacy, and new text end disclose the sources utilized for setting
maximum allowable cost price rates on each maximum allowable cost price list included
under the contract deleted text begin and identify each maximum allowable cost price list that applies to the
network pharmacy.deleted text end new text begin , including the following:
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(i) average acquisition cost, including national average drug acquisition cost;
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(ii) average manufacturer price;
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(iii) average wholesale price;
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new text begin (