HF 1872

2nd Engrossment - 88th Legislature (2013 - 2014) Posted on 03/24/2014 03:36pm

A bill for an act
relating to health; disclosing maximum allowable cost pricing used by pharmacy
benefit managers; proposing coding for new law in Minnesota Statutes, chapter
151.

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

Section 1.

new text begin [151.71] MAXIMUM ALLOWABLE COST PRICING.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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

new text begin (b) "Health plan company" has the meaning provided in section 62Q.01, subdivision
4.
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new text begin (c) "Pharmacy benefit manager" means an entity doing business in this state that
contracts to administer or manage prescription drug benefits on behalf of any health plan
company that provides prescription drug benefits to residents of this state.
new text end

new text begin Subd. 2. new text end

new text begin Pharmacy benefit manager contracts with pharmacies; maximum
allowable cost pricing. new text end

new text begin (a) In each contract between a pharmacy benefit manager and
a pharmacy, the pharmacy shall be given the right to obtain from the pharmacy benefit
manager a current list of the sources used to determine maximum allowable cost pricing.
The pharmacy benefit manager shall update the pricing information at least every seven
business days and provide a means by which contracted pharmacies may promptly review
current prices in an electronic, print, or telephonic format within one business day at no
cost to the pharmacy. A pharmacy benefit manager shall maintain a procedure to eliminate
products from the list of drugs subject to maximum allowable cost pricing in a timely
manner in order to remain consistent with changes in the marketplace.
new text end

new text begin (b) In order to place a prescription drug on a maximum allowable cost list, a
pharmacy benefit manager shall ensure that the drug is generally available for purchase by
pharmacies in this state from a national or regional wholesaler and is not obsolete.
new text end

new text begin (c) Each contract between a pharmacy benefit manager and a pharmacy must include
a process to appeal, investigate, and resolve disputes regarding maximum allowable cost
pricing that includes:
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new text begin (1) a 15-business day limit on the right to appeal following the initial claim;
new text end

new text begin (2) a requirement that the appeal be investigated and resolved within seven business
days after the appeal; and
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new text begin (3) a requirement that a pharmacy benefit manager provide a reason for any appeal
denial and identify the national drug code of a drug that may be purchased by the
pharmacy at a price at or below the maximum allowable cost price as determined by
the pharmacy benefit manager.
new text end

new text begin (d) If the appeal is upheld, the pharmacy benefit manager shall make an adjustment
to the maximum allowable cost price no later than one business day after the date of
determination. The pharmacy benefit manager shall make the price adjustment applicable
to all similarly situated network pharmacy providers as defined by the plan sponsor.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2015.
new text end