HF 4115

as introduced - 91st Legislature (2019 - 2020) Posted on 03/04/2020 03:38pm

A bill for an act
relating to health care; prohibiting pharmacy benefit managers from contractually
restricting pharmacies from discussing reimbursement amounts to enrollees or
health carriers; amending Minnesota Statutes 2019 Supplement, section 62W.11.

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

Section 1.

Minnesota Statutes 2019 Supplement, section 62W.11, is amended to read:

62W.11 GAG CLAUSE PROHIBITION.

(a) No contract between a pharmacy benefit manager or health carrier and a pharmacy
or pharmacist shall prohibit, restrict, or penalize a pharmacy or pharmacist from disclosing
to an enrollee any health care information that the pharmacy or pharmacist deems appropriate
regarding the nature of treatment; the risks or alternatives; the availability of alternative
therapies, consultations, or tests; the decision of utilization reviewers or similar persons to
authorize or deny services; the process that is used to authorize or deny health care services
or benefits; or information on financial incentives and structures used by the health carrier
or pharmacy benefit manager.

(b) A pharmacy or pharmacist must provide to an enrollee information regarding the
enrollee's total cost for each prescription drug dispensed where part or all of the cost of the
prescription is being paid or reimbursed by the employer-sponsored plan or by a health
carrier or pharmacy benefit manager, in accordance with section 151.214, subdivision 1.

(c) A pharmacy benefit manager or health carrier must not prohibit a pharmacist or
pharmacy from discussing information regarding the total cost for pharmacy services for a
prescription drug, including the patient's co-payment amount deleted text begin and deleted text end new text begin , new text end the pharmacy's own usual
and customary price deleted text begin of deleted text end new text begin for new text end the prescription new text begin drug, the pharmacy's acquisition cost for the
prescription drug, and the amount the pharmacy is being reimbursed by the pharmacy benefit
manager or health carrier for the prescription drug new text end .

new text begin (d) A pharmacy benefit manager must not prohibit a pharmacist or pharmacy from
discussing with a health carrier the amount the pharmacy is being paid or reimbursed for a
prescription drug by the pharmacy benefit manager or the pharmacy's acquisition cost for
a prescription drug.
new text end

deleted text begin (d) deleted text end new text begin (e) new text end A pharmacy benefit manager or health carrier must not prohibit a pharmacist or
pharmacy from discussing the availability of any therapeutically equivalent alternative
prescription drugs or alternative methods for purchasing the prescription drug, including
but not limited to paying out-of-pocket the pharmacy's usual and customary price when that
amount is less expensive to the enrollee than the amount the enrollee is required to pay for
the prescription drug under the enrollee's health plan.