This bill seeks to regulate pharmacy benefit managers (PBMs) in Minnesota by prohibiting spread pricing, which is the practice of charging health plans a different price for prescription drugs than what is paid to pharmacies. It establishes a fiduciary duty for PBMs to act in the best interests of health carriers and increases licensing application fees for PBMs from $8,500 to a range determined by the commissioner, between $15,000 and a higher amount. The bill also raises penalties for violations, increasing potential fines from $5,000 to a range between $10,000 and a higher amount, with a maximum of $25,000 per violation. Additionally, it mandates transparency by requiring annual financial reports from PBMs and prohibits certain fees related to claim adjudication.

Moreover, the bill amends existing laws to ensure equitable treatment of pharmacies and enrollees, prohibiting PBMs from imposing different limits on medication access based on ownership interests and ensuring that pharmacies are reimbursed fairly. It establishes guidelines for maximum allowable cost pricing, requiring timely updates to pharmacies and allowing them to challenge pricing discrepancies. The legislation also introduces new appeal processes for pricing decisions, prohibits retroactive claim adjustments under specific conditions, and includes provisions for increased staffing to enhance oversight and enforcement of PBM regulations. Overall, the bill aims to improve transparency, fairness, and access to medications while holding PBMs accountable for their practices.

Statutes affected:
Introduction: 62W.02, 62W.03, 62W.04, 62W.05, 62W.06, 62W.07, 62W.08, 62W.13