This bill seeks to reform the regulations governing pharmacy benefit managers (PBMs) in Minnesota, with a focus on enhancing transparency, accountability, and fairness in their pricing practices. Key provisions include the prohibition of "spread pricing," which prevents PBMs from charging health plans a different price for prescription drugs than what they pay pharmacies. The bill also raises the application and renewal fees for PBM licenses from $8,500 to a minimum of $15,000 and establishes fiduciary duties for PBMs to act in the best interests of health carriers. Furthermore, it mandates that PBMs provide detailed reports on drug pricing and rebates, ensuring greater transparency in their operations.

Additional amendments introduce a structured appeal process for pharmacies disputing maximum allowable cost pricing, requiring PBMs to resolve these appeals within 30 business days. If an appeal is upheld, PBMs must adjust the pricing to at least the pharmacy acquisition cost. The bill also restricts PBMs from making retroactive adjustments to prescription drug claims unless specific conditions, such as fraud or billing errors, are met. Overall, the legislation aims to protect pharmacies and consumers from unfair pricing practices while enhancing the enforcement of PBM regulations through increased staffing for the commissioner of commerce.

Statutes affected:
Introduction: 62W.02, 62W.03, 62W.04, 62W.05, 62W.06, 62W.08, 62W.13