SF 1116

as introduced - 90th Legislature (2017 - 2018) Posted on 02/17/2017 09:20am

A bill for an act
relating to health care; 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.576] ACCESS TO 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, administers, or manages 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 Retail community pharmacies. new text end

new text begin No health plan company or pharmacy benefit
manager shall:
new text end

new text begin (1) require an enrollee to exclusively obtain any prescription from a mail order pharmacy;
new text end

new text begin (2) impose upon an enrollee utilizing the retail community pharmacy a co-payment, fee,
or other condition not imposed upon enrollees electing to use a mail order pharmacy;
new text end

new text begin (3) subject any prescription dispensed by a retail community pharmacy to an enrollee
to a minimum or maximum quantity limit, length of script, restriction on refills, or other
requirement for obtaining refills that are not imposed upon a mail order prescription dispensed
by a mail order pharmacy;
new text end

new text begin (4) require an enrollee to pay for any of the prescription dispensed by a retail community
pharmacy and seek reimbursement if the enrollee is not required to pay for and seek
reimbursement in the same manner for a prescription dispensed by a mail order pharmacy;
new text end

new text begin (5) subject an enrollee to any administrative requirement to use a retail community
pharmacy that is not imposed upon the use of a mail order pharmacy; or
new text end

new text begin (6) impose any other term, condition, or requirement pertaining to the use of the services
of a retail community pharmacy that materially and unreasonably interferes with or impairs
the right of an enrollee to obtain prescriptions from a retail community pharmacy of the
enrollee's choice.
new text end

new text begin Subd. 5. 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

new text begin Subd. 6. new text end

new text begin Exclusion. new text end

new text begin This section does not apply to enrollees enrolled in a public health
care program under chapter 256B or 256L.
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 in 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 January 1, 2018, and apply to any health plan issued or
renewed on or after that date.
new text end