SF 5123

as introduced - 93rd Legislature (2023 - 2024) Posted on 04/12/2024 09:20am

A bill for an act
relating to human services; requiring the commissioner of human services to
establish a directed pharmacy dispensing payment to improve and maintain access
to pharmaceutical services; appropriating money; amending Minnesota Statutes
2022, section 256B.69, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2022, section 256B.69, is amended by adding a subdivision
to read:

new text begin Subd. 6h. new text end

new text begin Directed pharmacy dispensing payment. new text end

new text begin (a) The commissioner shall provide
a directed pharmacy dispensing payment of $4.50 per filled prescription to eligible outpatient
retail pharmacies in Minnesota to improve and maintain access to pharmaceutical services
in rural and underserved areas of the state. Managed care and county-based purchasing
plans delivering services under sections 256B.69 or 256B.692, and any pharmacy benefit
managers under contract with these entities, must pay the directed pharmacy dispensing
payment to eligible outpatient retail pharmacies for drugs dispensed to medical assistance
enrollees. The directed pharmacy dispensing payment is in addition to, and must not supplant
or reduce, any other dispensing fee paid by these entities to the pharmacy. Entities paying
the directed pharmacy dispensing payment must not reduce other payments to the pharmacy
as a result of payment of the directed pharmacy dispensing payment.
new text end

new text begin (b) For purposes of this subdivision, "eligible outpatient retail pharmacy" means an
outpatient retail pharmacy licensed under chapter 151 that is not owned, either directly or
indirectly or through an affiliate or subsidiary, by a pharmacy benefit manager licensed
under chapter 62W or a health carrier, as defined in section 62A.011, subdivision 2, and
that:
new text end

new text begin (1) is located in a medically underserved area or primarily serves a medically underserved
population, as defined by the United States Department of Health and Human Services
Health Resources and Services Administration under United States Code, title 42, section
254; or
new text end

new text begin (2) shares common ownership with 12 or fewer Minnesota pharmacies.
new text end

new text begin (c) In order to receive the directed pharmacy dispensing payment, a pharmacy must
submit to the commissioner a form, developed by the commissioner, attesting that the
pharmacy meets the requirements of paragraph (b).
new text end

new text begin (d) The commissioner shall set and adjust the amount of the directed pharmacy dispensing
payment to reflect the available state and federal funding.
new text end

new text begin (e) Managed care and county-based purchasing plans, and any pharmacy benefit managers
under contract with these entities, shall pay the directed pharmacy dispensing payment to
eligible outpatient retail pharmacies. The commissioner shall monitor the effect of this
requirement on access to pharmaceutical services in rural and underserved areas of the state.
If, for any contract year, federal approval is not received for this subdivision, the
commissioner must adjust the capitation rates paid to managed care plans and county-based
purchasing plans for that contract year to reflect removal of this subdivision. Contracts
between managed care plans and county-based purchasing plans, and any pharmacy benefit
managers under contract with these entities, and providers to whom this subdivision applies,
must allow recovery of payments from those providers if capitation rates are adjusted in
accordance with this paragraph. Payment recoveries must not exceed the amount equal to
any increase in rates that results from this subdivision. This subdivision expires if federal
approval is not received for this subdivision at any time.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 2. new text begin APPROPRIATION.
new text end

new text begin $....... in fiscal year 2025 is appropriated from the general fund to the commissioner of
human services to provide directed pharmacy dispensing payments under Minnesota Statutes,
section 256B.69, subdivision 6h. This appropriation is added to the base.
new text end