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SF 3584

as introduced - 91st Legislature (2019 - 2020) Posted on 02/25/2020 09:37am

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to health; limiting cost-sharing for prescription drugs; prohibiting pharmacy
benefit managers and health carriers from sharing prescription information with
affiliated pharmacies for commercial purposes and from requiring the use of mail
order pharmacies in specified circumstances; requiring pharmacy benefit managers
and health carriers to include lower cost generic drugs and interchangeable
biological products in their formularies; requiring wholesalers to report information
on repackaged drugs; appropriating money; amending Minnesota Statutes 2019
Supplement, sections 62Q.48; 62W.02, by adding a subdivision; 62W.07; proposing
coding for new law in Minnesota Statutes, chapters 62W; 151.

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

Section 1.

Minnesota Statutes 2019 Supplement, section 62Q.48, is amended to read:


62Q.48 COST-SHARING IN PRESCRIPTION deleted text beginINSULINdeleted text end DRUGS.

Subdivision 1.

Scope of coverage.

This section applies to all health plans issued or
renewed to a Minnesota resident.

Subd. 2.

Definitions.

(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given them.

(b) "Cost-sharing" means a deductible payment, co-payment, or coinsurance amount
imposed on an enrollee for a covered deleted text beginprescriptiondeleted text endnew text begin legendnew text end drug in accordance with the terms
and conditions of the enrollee's health plan.

(c) "Legend drug" has the same meaning as in section 151.01, subdivision 17.

deleted text begin (d) "Prescription insulin drug" means a legend drug that contains insulin and is used to
treat diabetes.
deleted text end

deleted text begin (e)deleted text endnew text begin (d)new text end "Net price" means the health plan company's cost for a deleted text beginprescription insulindeleted text endnew text begin legendnew text end
drug, including any rebates or discounts received by or accrued directly or indirectly to the
health plan company from a drug manufacturer or pharmacy benefit manager.

Subd. 3.

Cost-sharing limits.

(a) A health plan that imposes a cost-sharing requirement
on the coverage of a deleted text beginprescription insulindeleted text endnew text begin legendnew text end drug shall limit the total amount of
cost-sharing that an enrollee is required to pay at point of sale, including deductible payments
and the cost-sharing amounts charged once the deductible is met at an amount that does not
exceed the net price of the deleted text beginprescription insulindeleted text endnew text begin legendnew text end drug.

(b) Nothing in this section shall prevent a health plan company from imposing a
cost-sharing requirement that is less than the amount specified in paragraph (a).

Sec. 2.

Minnesota Statutes 2019 Supplement, section 62W.02, is amended by adding a
subdivision to read:


new text begin Subd. 1a. new text end

new text begin Affiliated pharmacy. new text end

new text begin "Affiliated pharmacy" means a retail pharmacy, mail
order pharmacy, specialty pharmacy, or other network pharmacy in which a pharmacy
benefit manager or health carrier has an ownership interest or in which the pharmacy provider
has an ownership interest in the pharmacy benefit manager or health carrier.
new text end

Sec. 3.

Minnesota Statutes 2019 Supplement, section 62W.07, is amended to read:


62W.07 PHARMACY OWNERSHIP INTEREST; PHARMACY SERVICES.

(a) A pharmacy benefit manager that has an ownership interest either directly or indirectly,
or through an affiliate or subsidiary, in a pharmacy must disclose to a plan sponsor that
contracts with the pharmacy benefit manager any difference between the amount paid to
that pharmacy and the amount charged to the plan sponsor.

(b) A pharmacy benefit manager or health carrier is prohibited from penalizing, requiring,
or providing financial incentives, including variations in premiums, deductibles, co-payments,
or coinsurance, to an enrollee as an incentive to use deleted text begina retail pharmacy, mail order pharmacy,
specialty pharmacy, or other network pharmacy provider in which a pharmacy benefit
manager has an ownership interest or in which the pharmacy provider has an ownership
interest in the pharmacy benefit manager
deleted text endnew text begin an affiliated pharmacynew text end.

(c) Paragraph (b) does not apply if the pharmacy benefit manager or health carrier offers
an enrollee the same financial incentives for using a network retail pharmacy, mail order
pharmacy, specialty pharmacy, or other network pharmacy in which the pharmacy benefit
manager has no ownership interest and the network pharmacy has agreed to accept the same
pricing terms, conditions, and requirements related to the cost of the prescription drug and
the cost of dispensing the prescription drug that are in the agreement with a network
pharmacy in which the pharmacy benefit manager has an ownership interest.

(d) A pharmacy benefit manager or health carrier is prohibited from imposing limits,
including quantity limits or refill frequency limits, on an enrollee's access to medication
that differ based solely on whether the deleted text beginhealth carrier or pharmacy benefit manager has an
ownership interest in a pharmacy or the pharmacy has an ownership interest in the pharmacy
benefit manager
deleted text endnew text begin enrollee receives the medication from an affiliated pharmacynew text end.

(e) Nothing in paragraph (d) shall be construed to prohibit a pharmacy benefit manager
from imposing different limits, including quantity limits or refill frequency limits on an
enrollee's access to medication based on whether the enrollee uses a mail order pharmacy
or retail pharmacy so long as the enrollee has the option to use a mail order pharmacy or
retail pharmacy with the same limits imposed in which the pharmacy benefit manager or
health carrier does not have an ownership interest.

(f) A pharmacy benefit manager or health carrier must not prohibit an entity authorized
to participate in the federal 340B Drug Pricing Program under section 340B of the Public
Health Service Act, United States Code, title 42, chapter 6A, or a pharmacy under contract
with such an entity to provide pharmacy services from participating in the pharmacy benefit
manager's or health carrier's provider network. A pharmacy benefit manager or health carrier
must not reimburse an entity or a pharmacy under contract with such an entity participating
in the federal 340B Drug Pricing Program differently than other similarly situated pharmacies.
A pharmacy benefit manager that contracts with a managed care plan or county-based
purchasing plan under contract with the commissioner of human services under chapter
256B or 256L must comply with this paragraph only if the entity or contracted pharmacy
can identify all claims eligible for 340B drugs at the time of initial claims submission at the
point of sale. This paragraph does not preclude a pharmacy benefit manager that contracts
with a managed care plan or county-based purchasing plan under contract with the
commissioner of human services under chapter 256B or 256L from reimbursing an entity
or pharmacy identified in this paragraph at a lower rate for any prescription drug purchased
by the entity or pharmacy through the federal 340B Drug Pricing Program.

new text begin (g) A pharmacy benefit manager or health carrier is prohibited from transferring or
sharing prescription information containing patient-identifiable or prescriber-identifiable
data to an affiliated pharmacy for any commercial purpose, except that this prescription
information may be exchanged solely for the purposes of pharmacy reimbursement, formulary
compliance, pharmacy care, or utilization review.
new text end

new text begin (h) A pharmacy benefit manager or health carrier is prohibited from requiring an enrollee
to use a mail order pharmacy if:
new text end

new text begin (1) the prescriber specifies in the prescription that face-to-face consultation with a
pharmacist is recommended for the safe and effective use of the prescription medication;
and
new text end

new text begin (2) the enrollee agrees with this recommendation and communicates this to the pharmacy
benefit manager or health carrier.
new text end

Sec. 4.

new text begin [62W.15] FORMULARY REQUIREMENTS.
new text end

new text begin (a) A pharmacy benefit manager or health carrier that includes a brand-name drug or
reference biological product in its formulary must also include generically equivalent drugs
to the brand-name drug and interchangeable biological products to the reference biological
product, if:
new text end

new text begin (1) the cost to the enrollee for the generically equivalent drug or interchangeable
biological product is less than the cost to the enrollee of the brand-name drug or reference
biological product; or
new text end

new text begin (2) the total cost of the generically equivalent drug or interchangeable biological product
is less than the total cost of the brand-name drug or reference biological product.
new text end

new text begin (b) For purposes of this section:
new text end

new text begin (1) "reference biological product" means the single biological product for which the
United States Food and Drug Administration has approved an initial biological product
license application, against which other biological products are evaluated for licensure as
biosimilar products or interchangeable biological products; and
new text end

new text begin (2) "total cost" means the sum of payment by the pharmacy benefit manager or health
carrier to the drug manufacturer or wholesaler, any rebates and fees received from the drug
manufacturer or wholesaler, and any enrollee cost-sharing for the drug or biological product.
new text end

Sec. 5.

new text begin [151.485] REPACKAGED DRUGS.
new text end

new text begin (a) Each wholesaler shall report to the board the following information, for each
prescription drug that it repackages for sale or distribution in Minnesota:
new text end

new text begin (1) the wholesaler's average acquisition cost for the prescription drug for the past calendar
year; and
new text end

new text begin (2) the wholesaler's average sale price to purchasers in Minnesota for the past calendar
year.
new text end

new text begin A wholesaler shall report this information to the board annually, by February 1 of each year,
beginning February 1, 2021, in the form and manner specified by the board, using the
definitions of average acquisition cost and average sale price specified by the board.
new text end

new text begin (b) The board shall report to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services policy and finance, by April
15 of each year, beginning April 15, 2021, summary results of the information reported by
wholesalers under paragraph (a), for each therapeutic category of prescription drugs. The
board shall include in the report an analysis of the extent to which the difference between
each wholesaler's average sale price for each therapeutic category of prescription drugs and
the wholesaler's average acquisition cost for that therapeutic category exceeds the board's
estimate of reasonable costs to the wholesaler for repackaging the drugs.
new text end

new text begin (c) The board may contract with a third party to implement and administer this section.
new text end

Sec. 6. new text beginAPPROPRIATION; BOARD OF PHARMACY.
new text end

new text begin $....... is appropriated from the general fund to the Board of Pharmacy for the fiscal year
ending June 30, 2021, to implement Minnesota Statutes, section 151.485.
new text end