HF 1587

as introduced - 89th Legislature (2015 - 2016) Posted on 03/24/2015 12:25am

A bill for an act
relating to insurance; requiring health plan companies to offer enrollees a choice
in pharmacy providers; requiring coverage for health care services provided
by licensed pharmacists; proposing coding for new law in Minnesota Statutes,
chapter 62Q.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [62Q.83] FREEDOM OF CHOICE FOR PHARMACY SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Enrollee choice. new text end

new text begin No health plan company or pharmacy benefit
manager that covers pharmaceutical services, including prescription drug coverage, shall
limit or restrict an enrollee's ability to select a pharmacy or pharmacist of the enrollee's
choice if the pharmacy or pharmacist is licensed under chapter 151, and the pharmacy
or pharmacist has agreed to the terms of the health plan company's or pharmacy benefit
manager's provider contract.
new text end

new text begin Subd. 2. new text end

new text begin Provider network. new text end

new text begin No health plan company or pharmacy benefit manager
shall deny a pharmacy or pharmacist the right to participate in any of its pharmacy network
contracts in this state or as a contracting provider in this state if the pharmacy or pharmacist
has a valid license under chapter 151, and the pharmacy or pharmacist agrees to accept the
terms and conditions offered by the health plan company or pharmacy benefit manager,
and agrees to provide pharmacy services that meet state and federal laws and regulations.
new text end

new text begin Subd. 3. new text end

new text begin Cost-sharing or other conditions. new text end

new text begin No health plan company or pharmacy
benefit manager shall impose a co-payment, fee, or other cost-sharing requirement
for selecting a pharmacy or pharmacist of the enrollee's choosing or impose other
conditions that limit or restrict an enrollee's ability to utilize a pharmacy of the enrollee's
choosing, unless the health plan company or pharmacy benefit manager imposes the
same cost-sharing requirements, fees, conditions, or limits upon an enrollee's selection of
any of the pharmacies within the health plan company's or pharmacy benefit manager's
provider network contracts in this state.
new text end

new text begin Subd. 4. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the terms in this subdivision
have the meanings given.
new text end

new text begin (b) "Pharmacy" has the meaning given in section 151.01, subdivision 2, and includes
mail order pharmacies and specialty pharmacies.
new text end

new text begin (c) "Pharmacy benefit manager" has the meaning given in section 151.71,
subdivision 1.
new text end

Sec. 2.

new text begin [62Q.84] SERVICES PERFORMED BY A PHARMACIST.
new text end

new text begin A health plan company or pharmacy benefit manager as defined under section
151.71, subdivision 1, shall provide payment for any health care service that is a covered
benefit and is performed by a licensed pharmacist if: (1) the service performed is within
the scope of practice of a licensed pharmacist under chapter 151; and (2) the health plan
would cover the service if the service was performed by a physician licensed under chapter
147; an advanced practice registered nurse licensed under section 148.211, subdivision
1a; or a physician assistant licensed under chapter 147A.
new text end

Sec. 3. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 and 2 are effective August 1, 2015, and apply to any health plan issued
or renewed on or after that date.
new text end