SF 4007

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/15/2022 09:25am

A bill for an act
relating to health care; requiring that an enrollee receive any rebates and discounts
accrued directly or indirectly to health carriers; proposing coding for new law in
Minnesota Statutes, chapter 62A.

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

Section 1.

new text begin [62A.3096] COST-SHARING REDUCTIONS AT POINT OF SALE.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given.
new text end

new text begin (b) "Defined cost-sharing" means a deductible or coinsurance amount imposed on an
enrollee for a covered prescription drug under the terms of the enrollee's health plan.
new text end

new text begin (c) "Health carrier" has the meaning given in section 62A.011, subdivision 2, and includes
a pharmacy benefit manager as defined in section 62W.02, subdivision 15, with respect to
the pharmacy benefit management services provided on behalf of a health carrier.
new text end

new text begin (d) "Price protection rebate" means a negotiated price concession that accrues directly
or indirectly to the health carrier, or other party on behalf of the health carrier, in the event
the wholesale acquisition cost of a drug increases above a specified threshold.
new text end

new text begin (e) "Rebate" means:
new text end

new text begin (1) negotiated price concessions, including but not limited to base price concessions,
whether described as a rebate or otherwise, and reasonable estimates of any price protection
rebates and performance-based price concessions that may accrue directly or indirectly to
the health carrier during the coverage year from a manufacturer, dispensing pharmacy, or
other party in connection with dispensing or administering a prescription drug; and
new text end

new text begin (2) reasonable estimates of any negotiated prices, concessions, fees, and other
administrative costs that are passed through to the health carrier and serve to reduce the
health carrier's liabilities for a prescription drug.
new text end

new text begin Subd. 2. new text end

new text begin Decrease in cost-sharing. new text end

new text begin (a) An enrollee's defined cost-sharing for each
prescription drug must be calculated at the point of sale based on a price that is reduced by
an amount equal to 100 percent of all rebates received or to be received in connection with
dispensing or administering the prescription drug.
new text end

new text begin (b) Nothing in this section precludes a health carrier from decreasing an enrollee's defined
cost-sharing by an amount greater than that required under this subdivision.
new text end

new text begin Subd. 3. new text end

new text begin Confidentiality. new text end

new text begin When complying with this section, a health carrier or the
health carrier's agents must not publish or otherwise reveal information regarding the actual
amount of rebates a health carrier receives on a product, therapeutic class of products,
manufacturer-specific basis, or pharmacy-specific basis. Rebate information is protected
as a trade secret, is not a public record under chapter 13, and must not be disclosed directly;
indirectly; in a manner that may identify an individual product, therapeutic class of products,
or manufacturer; or in a manner that has the potential to compromise the financial,
competitive, or proprietary nature of the information. A health carrier must impose the
confidentiality protections of this section on any vendor or downstream third party that
performs health care or administrative services on behalf of the health carrier that may
receive or have access to rebate information.
new text end

new text begin Subd. 4. new text end

new text begin Enforcement. new text end

new text begin A health carrier or pharmacy benefit manager that fails to comply
with this section may be subject to sanctions under the appropriate chapters regulating the
health carrier or pharmacy benefit manager, including civil penalties and suspension or
revocation of the health carrier's or pharmacy benefit manager's license.
new text end