This bill aims to modify the business practices of pharmacy benefit managers (PBMs) in Minnesota, focusing on enhancing transparency and fairness in their operations. Key provisions include the establishment of definitions for terms such as "pharmacy acquisition cost," "pharmaceutical wholesaler," and "spread pricing." The bill mandates that PBMs must not engage in deceptive advertising, charge pharmacies fees related to claim adjudication, or impose accreditation standards that exceed those set by the board of pharmacy. Additionally, it prohibits PBMs from conducting spread pricing and requires them to reimburse pharmacies at least the national average drug acquisition cost or wholesale acquisition cost.

The legislation also introduces new requirements for maximum allowable cost pricing, ensuring that PBMs provide timely updates on pricing changes and allowing pharmacies to challenge prices that do not meet specified criteria. It establishes an appeal process for pharmacies to contest maximum allowable cost prices, with stipulations for timely resolution and adjustments if appeals are upheld. Furthermore, the bill prohibits retroactive adjustments to claims unless they are based on specific audit findings or technical billing errors. Overall, the bill seeks to create a more equitable framework for pharmacy reimbursement and enhance the accountability of pharmacy benefit managers.

Statutes affected:
Introduction: 62W.02, 62W.04, 62W.08, 62W.13