1.1                          A bill for an act 
  1.2             relating to health; requiring drug manufacturers to 
  1.3             provide rebates for drugs purchased by the uninsured; 
  1.4             proposing coding for new law in Minnesota Statutes, 
  1.5             chapter 256. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  [256.956] [PRESCRIPTION DRUG DISCOUNT PROGRAM.] 
  1.8      Subdivision 1.  [ESTABLISHMENT.] The commissioner of human 
  1.9   services shall establish and administer the prescription drug 
  1.10  discount program.  The commissioner may contract with a pharmacy 
  1.11  benefit manager to administer the program.  
  1.12     Subd. 2.  [DEFINITIONS.] For the purpose of this section, 
  1.13  the definitions in paragraphs (a) to (e) have the meanings given 
  1.14  them. 
  1.15     (a) "Health plan" has the meaning provided in section 
  1.16  62Q.01, subdivision 3.  
  1.17     (b) "Health plan company" has the meaning provided in 
  1.18  section 62Q.01, subdivision 4. 
  1.19     (c) "Manufacturer" means a manufacturer as defined in 
  1.20  section 151.44, paragraph (c). 
  1.21     (d) "Prescription drug" means a drug as defined in section 
  1.22  151.44, paragraph (d), that is covered under medical assistance 
  1.23  as described in section 256B.0625, subdivision 13. 
  1.24     (e) "Participating pharmacy" means a pharmacy as defined in 
  1.25  section 151.01, subdivision 2, that agrees to participate in the 
  2.1   prescription drug discount program.  This definition does not 
  2.2   include a pharmacy operated by a health maintenance organization 
  2.3   or a hospital.  
  2.4      Subd. 3.  [ELIGIBILITY.] To be eligible for the program, an 
  2.5   applicant must: 
  2.6      (1) not be eligible for medical assistance or general 
  2.7   assistance medical care without a spenddown, or enrolled in the 
  2.8   MinnesotaCare program or the senior citizen drug program 
  2.9   established under section 256.955; 
  2.10     (2) not be enrolled in prescription drug coverage under a 
  2.11  health plan, except as provided under subdivision 12; 
  2.12     (3) not be enrolled in prescription drug coverage under a 
  2.13  Medicare supplement plan as defined in sections 62A.31 to 
  2.14  62A.44, or policies, contracts, or certificates that supplement 
  2.15  Medicare issued by health maintenance organizations or those 
  2.16  policies, contracts, or certificates governed by section 1833 or 
  2.17  1876 of the federal Social Security Act; United States Code, 
  2.18  title 42, section 1395, et seq., as amended, except as provided 
  2.19  under subdivision 12; and 
  2.20     (4) be a permanent resident of Minnesota as defined in 
  2.21  section 256L.09.  
  2.22     Subd. 4.  [APPLICATION.] (a) Applications and information 
  2.23  on the program must be made available at participating 
  2.24  pharmacies and at health care provider offices.  Individuals 
  2.25  must submit any information specified by the commissioner as 
  2.26  being necessary to verify eligibility directly to the 
  2.27  commissioner.  The commissioner shall determine an applicant's 
  2.28  eligibility for the program within 30 days from the date the 
  2.29  application is received.  Once eligibility has been verified, 
  2.30  the commissioner shall issue a drug purchase identification card 
  2.31  to the eligible individual.  Eligibility begins the month after 
  2.32  approval and must be renewed annually.  
  2.33     (b) The commissioner shall develop an application form that 
  2.34  does not exceed one page in length, allows for the use of 
  2.35  information from an applicant's state income tax form, and 
  2.36  requests information on monthly medical expenses and assets to 
  3.1   determine potential eligibility for medical assistance or 
  3.2   general assistance medical care.  
  3.3      Subd. 5.  [PARTICIPATING PHARMACY.] Pursuant to a valid 
  3.4   prescription, a participating pharmacy must sell any 
  3.5   prescription drug to an eligible individual at the pharmacy's 
  3.6   usual and customary retail price, minus an amount that is equal 
  3.7   to the rebate amount described in subdivision 7, and plus an 
  3.8   administration fee established by the commissioner.  For 
  3.9   individuals eligible for the program under subdivision 12, the 
  3.10  participating pharmacy shall collect the copayment required 
  3.11  under the enrollee's health plan and shall be reimbursed for the 
  3.12  prescription drug in accordance with any agreement or contract 
  3.13  between the health plan company and the pharmacy.  Each 
  3.14  participating pharmacy shall provide the commissioner with all 
  3.15  information the commissioner determines is necessary to 
  3.16  administer the program, including, but not limited to, 
  3.17  information on prescription drug sales to eligible individuals 
  3.18  and usual and customary retail prices.  
  3.19     Subd. 6.  [NOTIFICATION.] On a biweekly basis, the 
  3.20  commissioner shall notify each drug manufacturer of the amount 
  3.21  of rebate owed on the prescription drugs sold by a participating 
  3.22  pharmacy to eligible individuals in the previous two-week period.
  3.23     Subd. 7.  [REBATE.] As a condition of doing business in the 
  3.24  state, a manufacturer must provide a rebate equal to the rebate 
  3.25  provided under the medical assistance program for any 
  3.26  prescription drug sold or distributed by the manufacturer that 
  3.27  is purchased by an eligible individual at a participating 
  3.28  pharmacy.  The rebate must be paid to the commissioner within 15 
  3.29  days of notification of the amount owed. 
  3.30     Subd. 8.  [DISTRIBUTION.] The commissioner shall distribute 
  3.31  the amount collected under subdivision 7 to each participating 
  3.32  pharmacy based on the prescription drugs sold by that pharmacy 
  3.33  to eligible individuals during the previous two-week period, 
  3.34  minus the administrative fee.  Any amount collected for 
  3.35  prescription drugs sold by the pharmacy to an individual 
  3.36  eligible under subdivision 12 shall be distributed to the health 
  4.1   plan company, minus the administrative fee.  
  4.2      Subd. 9.  [ADMINISTRATIVE FEE.] The commissioner may 
  4.3   establish an administrative fee that covers the commissioner's 
  4.4   expenses for enrollment, processing claims, and distributing 
  4.5   rebates under this program.  
  4.6      Subd. 10.  [SPECIAL ACCOUNT.] The administrative fee 
  4.7   collected by the commissioner shall be deposited in the state 
  4.8   treasury and credited to a special account.  Money in the 
  4.9   account is appropriated to the commissioner to pay for the costs 
  4.10  of administering this program.  
  4.11     Subd. 11.  [ENFORCEMENT.] The attorney general may 
  4.12  institute a civil action in the name of the state in district 
  4.13  court against any manufacturer that fails to provide the rebates 
  4.14  described in subdivision 7 or fails to provide these rebates 
  4.15  within the designated time period in subdivision 7. 
  4.16     Subd. 12.  [OPTIONAL PARTICIPATION.] Individuals enrolled 
  4.17  in prescription drug coverage under a health plan are eligible 
  4.18  for the program if the health plan has no discount or rebate 
  4.19  agreements with manufacturers or discontinues its discount or 
  4.20  rebate agreements with manufacturers.