SF 3394

as introduced - 90th Legislature (2017 - 2018) Posted on 07/05/2018 02:38pm

A bill for an act
relating to health; establishing requirements for contracts between pharmacy benefit
managers and pharmacies; amending Minnesota Statutes 2016, section 151.71.

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

Section 1.

Minnesota Statutes 2016, section 151.71, is amended to read:

151.71 deleted text begin MAXIMUM ALLOWABLE COST PRICING deleted text end new text begin PHARMACY BENEFIT
MANAGER CONTRACTS WITH PHARMACIES new text end .

Subdivision 1.

Definitions.

(a) For purposes of this section, the following definitions
apply.

(b) new text begin "Health plan" has the meaning provided in section 62Q.01, subdivision 3.
new text end

new text begin (c) new text end "Health plan company" has the meaning provided in section 62Q.01, subdivision 4.

deleted text begin (c) deleted text end new text begin (d) new text end "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 begin Subd. 1a. new text end

new text begin Applicability; enforcement. new text end

new text begin (a) This section applies to all contracts between
a pharmacy benefit manager and a pharmacy.
new text end

new text begin (b) The board shall monitor and enforce compliance with the requirements of this section.
The board may assess a civil penalty on a pharmacy benefit manager for a violation of this
section, using the procedures specified in section 151.071, subdivision 1, clause (6).
new text end

Subd. 2.

deleted text begin Pharmacy benefit manager contracts with pharmacies; deleted text end Maximum allowable
cost pricing.

(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.

(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.

(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:

(1) a 15-business day limit on the right to appeal following the initial claim;

(2) a requirement that the appeal be investigated and resolved within seven business
days after the appeal is received; and

(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.

(d) If an 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 begin Subd. 3. new text end

new text begin Synchronization of refills. new text end

new text begin (a) For purposes of this subdivision,
"synchronization" means the coordination of prescription drug refills for a patient taking
two or more medications for one or more chronic conditions, to allow the patient's
medications to be refilled on the same schedule for a given period of time.
new text end

new text begin (b) A contract between a pharmacy benefit manager and a pharmacy must allow for
synchronization of prescription drug refills for a patient on at least one occasion per year,
if all of the following criteria are met:
new text end

new text begin (1) the prescription drugs are covered under the patient's health plan or have been
approved by a formulary exceptions process;
new text end

new text begin (2) the prescription drugs are maintenance medications as defined by the health plan
and have one or more refills available at the time of synchronization;
new text end

new text begin (3) the prescription drugs are not Schedule II, III, or IV controlled substances;
new text end

new text begin (4) the patient meets all utilization management criteria relevant to the prescription drug
at the time of synchronization;
new text end

new text begin (5) the prescription drugs are of a formulation that can be safely split into short-fill
periods to achieve synchronization; and
new text end

new text begin (6) the prescription drugs do not have special handling or sourcing needs that require a
single, designated pharmacy to fill or refill the prescription.
new text end

new text begin (c) When necessary to permit synchronization, the pharmacy benefit manager shall apply
a prorated, daily patient cost-sharing rate to any prescription drug dispensed by a pharmacy
under this subdivision. The dispensing fee shall not be prorated, and all dispensing fees
shall be based on the number of prescriptions filled or refilled.
new text end

new text begin Subd. 4. new text end

new text begin Mailing or delivery of drugs. new text end

new text begin A contract between a pharmacy benefit manager
and a pharmacy must allow a pharmacy or pharmacist to mail or deliver drugs to a patient
as an ancillary service of the pharmacy. A pharmacy benefit manager may not prohibit a
pharmacist or pharmacy from charging a shipping and handling fee to a patient for each
prescription mailed or delivered.
new text end

new text begin Subd. 5. new text end

new text begin Use of mail order not required. new text end

new text begin A contract between a pharmacy benefit
manager and a pharmacy must permit each patient to fill any mail order covered prescription,
at the patient's option, at any network participating non-mail order pharmacy, if the network
participating non-mail order pharmacy offers to accept reimbursement that is comparable
to that which would be paid to the mail order pharmacy. The contract must not require a
patient electing to fill a prescription at a network participating non-mail order pharmacy to
pay higher cost-sharing than that which would otherwise apply if the patient filled the
prescription at the mail order pharmacy.
new text end