HF 2075

1st Engrossment - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; limiting a contracting
agreement between health plans or pharmacy benefits
manager and pharmacies; amending Minnesota Statutes
2004, section 295.582.

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

Section 1.

Minnesota Statutes 2004, section 295.582, is
amended to read:

295.582 AUTHORITY.

new text begin Subdivision 1. new text end

new text begin Wholesale drug distributor tax. new text end

(a) A
hospital, surgical center, or health care provider that is
subject to a tax under section 295.52, or a pharmacy that has
paid additional expense transferred under this section by a
wholesale drug distributor, may transfer additional expense
generated by section 295.52 obligations on to all third-party
contracts for the purchase of health care services on behalf of
a patient or consumer. The additional expense transferred to
the third-party purchaser must not exceed the tax percentage
specified in section 295.52 multiplied against the gross
revenues received under the third-party contract, and the tax
percentage specified in section 295.52 multiplied against
co-payments and deductibles paid by the individual patient or
consumer. The expense must not be generated on revenues derived
from payments that are excluded from the tax under section
295.53. All third-party purchasers of health care services
including, but not limited to, third-party purchasers regulated
under chapter 60A, 62A, 62C, 62D, 62H, 62N, 64B, 65A, 65B, 79,
or 79A, or under section 471.61 or 471.617, new text begin and a pharmacy
benefits manager new text end must pay the transferred expense in addition to
any payments due under existing contracts with the hospital,
surgical center, pharmacy, or health care provider, to the
extent allowed under federal law. A third-party purchaser of
health care services includes, but is not limited to, a health
carrier or community integrated service network that pays for
health care services on behalf of patients or that reimburses,
indemnifies, compensates, or otherwise insures patients for
health care services new text begin and for purposes of this section, a
pharmacy benefits manager means an entity that performs pharmacy
benefits management new text end . A third-party purchaser shall comply with
this section regardless of whether the third-party purchaser is
a for-profit, not-for-profit, or nonprofit entity. A wholesale
drug distributor may transfer additional expense generated by
section 295.52 obligations to entities that purchase from the
wholesaler, and the entities must pay the additional expense.
Nothing in this section limits the ability of a hospital,
surgical center, pharmacy, wholesale drug distributor, or health
care provider to recover all or part of the section 295.52
obligation by other methods, including increasing fees or
charges. new text begin Nothing shall prohibit a pharmacy from passing on
additional fees or charges to a pharmacy benefits manager.
new text end

(b) Each third-party purchaser regulated under any chapter
cited in paragraph (a) shall include with its annual renewal for
certification of authority or licensure documentation indicating
compliance with paragraph (a).

(c) Any hospital, surgical center, or health care provider
subject to a tax under section 295.52 or a pharmacy that has
paid additional expense transferred under this section by a
wholesale drug distributor may file a complaint with the
commissioner responsible for regulating the third-party
purchaser if at any time the third-party purchaser fails to
comply with paragraph (a).

(d) If the commissioner responsible for regulating the
third-party purchaser finds at any time that the third-party
purchaser has not complied with paragraph (a), the commissioner
may take enforcement action against a third-party purchaser
which is subject to the commissioner's regulatory jurisdiction
and which does not allow a hospital, surgical center, pharmacy,
or provider to pass-through the tax. The commissioner may by
order fine or censure the third-party purchaser or revoke or
suspend the certificate of authority or license of the
third-party purchaser to do business in this state if the
commissioner finds that the third-party purchaser has not
complied with this section. The third-party purchaser may
appeal the commissioner's order through a contested case hearing
in accordance with chapter 14.

new text begin Subd. 2. new text end

new text begin Agreement. new text end

new text begin A contracting agreement between a
health plan company or a pharmacy benefits manager and a
resident or nonresident pharmacy registered under chapter 151,
may not prohibit:
new text end

new text begin (1) a pharmacy that has paid additional expense transferred
under this section by a wholesale drug distributor from
exercising its option under this section to transfer such
additional expenses generated by the section 295.52 obligations
on to the health plan company, a pharmacy benefits manager, or a
third-party purchaser; or
new text end

new text begin (2) a pharmacy that is subject to tax under section 295.52,
subdivision 4, from exercising its option under this section to
recover all or part of the section 295.52 obligations from the
health plan company, a pharmacy benefits manager, or a
third-party purchaser by other methods, including increasing
fees or charges.
new text end