SF 2268

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; requiring the disclosure of financial information and
arrangements related to prescription drug purchasing; requiring rulemaking;
providing civil penalties; amending Minnesota Statutes 2006, section 151.061,
subdivision 2; proposing coding for new law as Minnesota Statutes, chapter
151A.

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

Section 1.

Minnesota Statutes 2006, section 151.061, subdivision 2, is amended to read:

Subd. 2.

Remedy.

Any person injured by unfair discrimination as defined in
subdivision 1 may bring a civil action and recover damages, together with costs and
disbursements, including reasonable attorney's fees, and receive other equitable relief as
determined by the court. The remedies provided by this section are cumulative and shall
not be construed as restricting any remedy which is otherwise available. new text begin The attorney
general may enforce this section pursuant to the authority in section 8.31.
new text end

Sec. 2.

new text begin [151A.01] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Application. new text end

new text begin The definitions in this section apply to this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of health.
new text end

new text begin Subd. 3. new text end

new text begin Covered entity. new text end

new text begin "Covered entity" means a hospital; a health maintenance
organization operating under chapter 62D; an insurance company licensed under chapter
60A; a nonprofit health service plan corporation operating under chapter 62C; a fraternal
benefit society operating under chapter 64B; a joint self-insurance employee health plan
operating under chapter 62H; a health program administered by a department or the state
in the capacity of provider of health coverage; or an employer, labor union, or other group
of persons organized in the state that provides health coverage to covered individuals who
are employed or reside in the state. Covered entity does not include a self-funded plan
that is exempt from state regulation pursuant to the Employee Retirement and Income
Security Act; a plan issued for coverage for federal employees; or a health plan that
provides coverage only for accidental injury, a specified disease, hospital indemnity,
Medicare supplement, disability income, long-term care, or other limited benefit health
insurance policies and contracts.
new text end

new text begin Subd. 4. new text end

new text begin Covered individual. new text end

new text begin "Covered individual" means a member, participant,
enrollee, contract holder, policyholder, or beneficiary of a covered entity who is provided
health coverage by the covered entity. Covered individual includes a dependent or
other person provided health coverage through a policy, contract, or plan for a covered
individual.
new text end

new text begin Subd. 5. new text end

new text begin Generic drug. new text end

new text begin "Generic drug" means a chemically equivalent copy of a
brand name drug with an expired patent.
new text end

new text begin Subd. 6. new text end

new text begin Labeler. new text end

new text begin "Labeler" means an entity or person that receives prescription
drugs from a manufacturer or wholesaler and repackages those drugs for later retail sale
and that has a labeler code from the federal Food and Drug Administration under Code of
Federal Regulations, title 21, section .
new text end

new text begin Subd. 7. new text end

new text begin Pharmacy benefits management. new text end

new text begin "Pharmacy benefits management"
means the procurement of prescription drugs at a negotiated rate for dispensation within
the state to covered individuals, the administration or management of prescription drug
benefits provided by a covered entity for the benefit of covered individuals, or any of the
following services provided with regard to the administration of pharmacy benefits:
new text end

new text begin (1) mail service pharmacy;
new text end

new text begin (2) claims processing, retail network management, and payment of claims to
pharmacies for prescription drugs dispensed to covered individuals;
new text end

new text begin (3) clinical formulary development and management services;
new text end

new text begin (4) rebate contracting and administration;
new text end

new text begin (5) patient compliance, therapeutic intervention, and generic substitution programs;
and
new text end

new text begin (6) disease management programs.
new text end

new text begin Subd. 8. new text end

new text begin Pharmacy benefits manager. new text end

new text begin "Pharmacy benefits manager" means an
entity that performs pharmacy benefits management. Pharmacy benefits manager includes
a person or entity acting for a pharmacy benefits manager in a contractual or employment
relationship in the performance of pharmacy benefits management for a covered entity and
includes mail service pharmacy.
new text end

Sec. 3.

new text begin [151A.03] CERTIFICATE OF AUTHORITY.
new text end

new text begin No person or entity may perform or act as a pharmacy benefits manager in this
state without a valid certificate of authority issued by the commissioner. Each person or
entity seeking a certificate of authority to act as a pharmacy benefits manager shall file
with the commissioner an application for a certificate of authority upon a form to be
furnished by the commissioner and a filing fee to be determined by the commissioner. The
commissioner may establish a filing fee notwithstanding section 16A.1283.
new text end

Sec. 4.

new text begin [151A.05] DISCLOSURE.
new text end

new text begin (a) Each pharmacy benefits manager shall provide to a covered entity and any other
person that it contracts with in the state:
new text end

new text begin (1) all financial and utilization information requested by the covered entity relating to
the provision of benefits to covered individuals through that covered entity and all financial
and utilization information relating to services to that covered entity or person; and
new text end

new text begin (2) all financial terms and arrangements for remuneration of any kind that apply
between the pharmacy benefits manager and any prescription drug manufacturer,
labeler, or pharmacy, including formulary management and drug-switch programs,
educational support, claims processing, pharmacy network fees that are charged from
retail pharmacies, and data sales fees.
new text end

new text begin (b) The pharmacy benefits manager shall provide all information identified in
paragraph (a), clause (2), to the commissioner and the attorney general's office. The
information may be used for law enforcement purposes, including the enforcement
of section 151.061.
new text end

Sec. 5.

new text begin [151A.07] DISPENSATION OF SUBSTITUTE PRESCRIPTION DRUG.
new text end

new text begin (a) With regard to the dispensation of a substitute prescription drug for a prescribed
drug to a covered individual, the following provisions apply:
new text end

new text begin (1) the pharmacy benefits manager may request the substitution of a lower-priced
generic and therapeutically equivalent drug for a higher-priced prescribed drug; and
new text end

new text begin (2) if the substitute drug costs more than the prescribed drug, the substitution must
only be made for medical reasons that benefit the covered individual.
new text end

new text begin (b) Before a substitution is made under this section, the pharmacy benefits manager
shall obtain approval of the prescribing health professional and must disclose to the
covered individual and the covered entity the cost of both drugs and any benefit or
payment directly or indirectly accruing to the pharmacy benefits manager as a result
of the substitution.
new text end

Sec. 6.

new text begin [151A.09] ENFORCEMENT.
new text end

new text begin The commissioner shall enforce this chapter, including the suspension or revocation
of the authority of a pharmacy benefits manager to provide pharmacy benefits management
in this state for a violation of this chapter or the imposition of a monetary penalty not to
exceed $25,000 for each violation. The attorney general may pursue the penalties and
remedies available to the attorney general under section 8.31 for any violation of this
chapter.
new text end

Sec. 7.

new text begin [151A.11] RULES.
new text end

new text begin The commissioner shall adopt rules to issue a certificate of authority and to enforce
this chapter.
new text end

Sec. 8.

new text begin [151A.13] CIVIL ACTION.
new text end

new text begin A covered entity may bring a civil action to enforce the provisions of this chapter
or to seek civil damages for the violation of this chapter.
new text end