This bill seeks to reform the operations of pharmacy benefit managers (PBMs) in Minnesota by implementing stricter regulations and enhancing transparency. Key changes include the prohibition of "spread pricing," which occurs when the price charged to health plans differs from what pharmacies receive. The bill 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 prioritize the interests of health carriers. Additionally, it mandates that PBMs provide detailed reports on drug pricing and rebates to the commissioner of commerce, thereby promoting accountability in the sector.

The legislation also introduces a structured appeal process for pharmacies contesting maximum allowable cost pricing, requiring appeals to be submitted within 30 business days and resolved by PBMs within the same timeframe. If an appeal is successful, PBMs must adjust their pricing to reflect at least the pharmacy acquisition cost. The bill further prohibits retroactive adjustments to prescription drug claims by PBMs unless specific conditions are met, and allows pharmacies to refuse to provide drugs or services if reimbursement falls below their acquisition cost. To facilitate these changes, the bill includes funding for the commissioner of commerce to bolster staff dedicated to enforcing PBM regulations.

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