Minnesota Legislature
HF 4890
as introduced - 93rd Legislature (2023 - 2024) Posted on 03/13/2024 12:18pm
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A bill for an act
relating to state government; changing provisions covering technology platform,
pharmacy benefit manager, and data protection in vendor contracts; amending
Minnesota Statutes 2022, section 43A.231, subdivisions 4, 5, 6.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2022, section 43A.231, subdivision 4, is amended to read:
Subd. 4.
Technology platform.
(a) deleted text begin At least three months before the reverse auction
process is scheduled to be completed,deleted text end The commissioner shall procure through a competitive
bidding process a contract with a professional services vendor for a technology platform
and any associated professional services necessary to operate the platform to:
(1) evaluate the qualifications of prospective pharmacy benefit manager bidders for the
pharmacy benefit manager procurement;
(2) automatically adjudicate prescription drug claims; and
(3) collect data on pharmacy reimbursement.
(b) The platform procured under paragraph (a) must have the following capabilities to
ensure optimal performance of the reverse auction and security of data:
(1) host and conduct an online automated reverse auction:
(i) using a software application and high-performance data infrastructure to intake,
cleanse, and normalize pharmacy benefit manager data; and
(ii) with development methods and information security standards that have been validated
by receiving Service Organization Control 2 (SOC 2) and National Institute of Standards
and Technology certification;
(2) automate repricing of diverse and complex pharmacy benefit manager prescription
drug pricing proposals to enable direct comparisons of the price of bids using all annual
claims data available for the program using code-based classification or prescription drugs
from nationally accepted drug sources;
(3) simultaneously evaluatedeleted text begin , within six hours,deleted text end diverse and complex multiple proposals
from full-service pharmacy benefit managers that shall include at least guaranteed net cost,
Average Wholesale Price and National Average Drug Acquisition Cost (NADAC) pricing
models, as well as proposals from pharmacy benefit administrators and specialty drug and
rebate carve-out services providers;new text begin and
new text end
(4) produce an automated report and analysis of bids, including ranking of bids on the
comparative costs and qualitative aspects of the costs deleted text begin within six hoursdeleted text end after the close of
each round of reverse auction biddingdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(5) after the close of the reverse auction process, perform an electronic, line-by-line,
claim-by-claim review of all invoiced pharmacy benefit manager claims within six hours
of receipt that allows for an online comparison of pharmacy benefit manager invoices and
identifies all deviations from the specific terms of the services contract resulting from the
reverse auction.
deleted text end
(c) The commissioner may require additional capabilities or more rigorous standards
than those specified in paragraph (b).
(d) The commissioner shall not award the platform technology vendor contract under
this subdivision to:
(1) a pharmacy benefit manager;
(2) a subsidiary or affiliate of a pharmacy benefit manager; or
(3) a vendor who is managed by a pharmacy benefit manager or who receives, directly
or indirectly, remuneration from a pharmacy benefit manager for aggregating clients into
a contractual relationship with a pharmacy benefit manager.
deleted text begin (e) The vendor who is awarded the contract under this subdivision must not subcontract
any part of the reverse auction process or the review described under paragraph (b), clause
(5)deleted text end .new text begin The commissioner shall also hire a vendor to perform an electronic, line-by-line,
claim-by-claim review of all invoiced pharmacy benefit manager claims that allows for an
online comparison of pharmacy benefit manager invoices and identifies all deviations from
the specific terms of the services contract resulting from the reverse auction. The claim
review vendor and the platform vendor may be the same or they may be distinct.
new text end
Sec. 2.
Minnesota Statutes 2022, section 43A.231, subdivision 5, is amended to read:
Subd. 5.
Report; savings determination; process for selecting successor pharmacy
benefit manager.
(a) The commissioner of management and budget, with the assistance of
an actuarial consultant, shall compare the following: (1) actual, electronically adjudicated
prescription drug costs under the first two years of the contract that begins on January 1,
2023, with a pharmacy benefit manager that was selected by the reverse auction; and (2) a
projection of what prescription drug costs would have been for those same two years under
the pharmacy benefit manager contract in effect from 2018 to 2022, deleted text begin with appropriate
adjustment for any adopteddeleted text end new text begin considering either materialnew text end formulary or beneficiary utilization
changes. The projection deleted text begin must usedeleted text end new text begin may also consider new text end industry-recognized data sourcesnew text begin , or
bothnew text end . new text begin The comparison shall also factor in the costs of the vendor contracts hired by the
commissioner under this section. new text end The commissioner of management and budget shall report
the results of the comparison to the legislative auditor and to the chairs and ranking minority
members of the committees in the senate and house of representatives with jurisdiction over
state government finance and policy by deleted text begin Marchdeleted text end new text begin Septembernew text end 1, 2025.
(b) The commissioner of management and budget must require the actuarial consultant
to take appropriate measures to ensure that the consultant's work is not compromised by a
conflict of interest.
(c) By deleted text begin Aprildeleted text end new text begin Octobernew text end 1, 2025, the legislative auditor shall provide a report to the
commissioner of management and budget and to the chairs and ranking minority members
of the committees in the senate and house of representatives with jurisdiction over state
government finance and policy. The legislative auditor's report must make a determination
as to whether the commissioner's report accurately performs the comparison required under
paragraph (a).
(d) The deleted text begin technology platform vendordeleted text end new text begin vendors hired under this sectionnew text end shall provide to
the commissioner of management and budget and to the legislative auditor the electronically
adjudicated prescription drug data and any other support or assistance required by the
commissioner of management and budget to prepare a report and for the legislative auditor
to validate the accuracy of the commissioner's results of the comparison, by deadlines
established by the commissioner of management and budget and the legislative auditor.
Individual-identifying data received from the technology platform vendor is private data
on individuals, as defined by section 13.02, subdivision 12.
(e) If the commissioner of management and budget determines thatnew text begin meaningfulnew text end savings
on prescription drug costs were not achieved, based on the comparison required under
paragraph (a), deleted text begin with appropriate adjustment for any adopteddeleted text end new text begin considering either materialnew text end
formulary or beneficiary utilization changes, new text begin or both,new text end new text begin new text end the commissioner may forego the use
of a reverse auction for procurement of a successor pharmacy benefit manager contract. If
the commissioner of management and budget determines that new text begin meaningful new text end savings have been
achieved, the commissioner must select the successor pharmacy benefit manager contract
using the reverse auction process described in this section. If the commissioner's comparison
in paragraph (a) finds that new text begin meaningful new text end savings are not achieved, the commissioner's report
under paragraph (a) must include the commissioner's findings that support a determination
that new text begin meaningful new text end savings were not achieved, analysis of the factors that caused a failure to
achieve new text begin meaningful new text end savings, and recommendations for how new text begin meaningful new text end savings could be
achieved in the next contract with a pharmacy benefit manager.
Sec. 3.
Minnesota Statutes 2022, section 43A.231, subdivision 6, is amended to read:
Subd. 6.
Data protections.
The commissioner of management and budget may only
enter into an agreement with deleted text begin a technology platform vendordeleted text end new text begin vendors under this sectionnew text end if the
deleted text begin agreementdeleted text end new text begin agreementsnew text end provides privacy protections for data collected and maintained by
the deleted text begin technology platformdeleted text end deleted text begin vendordeleted text end new text begin vendorsnew text end , including:
(1) procedures for the prevention of unauthorized access or use;
(2) a prohibition on the sale of data collected and maintained as provided in the
agreement; and
(3) a prohibition on dissemination of data unless authorized by state or federal law or
the agreement.