This bill seeks to reform the regulations governing pharmacy benefit managers (PBMs) in Minnesota by addressing procurement practices, pricing transparency, and fiduciary responsibilities. A significant provision is 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 introduces new fiduciary duties requiring PBMs to act in the best interests of health carriers. Furthermore, it mandates that PBMs cannot charge pharmacies fees related to claim adjudication and must establish fair reimbursement practices.

In addition to these changes, the bill enhances transparency by requiring PBMs to submit annual reports on their pricing structures, rebates, and fees, which will be published by the commissioner of commerce. It establishes a process for pharmacies to appeal PBM decisions on maximum allowable cost pricing, with specific timelines for submission and resolution of appeals. If an appeal is upheld, the PBM must adjust the pricing accordingly. The bill also restricts PBMs from making retroactive adjustments to claims unless under certain conditions and allows pharmacies to refuse services if reimbursement is below acquisition costs. To support these regulatory changes, the bill includes funding for the commissioner of commerce to bolster staff for investigating and enforcing PBM regulations.

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