Bill Text: MN HF1872 | 2013-2014 | 88th Legislature | Engrossed
Bill Title: Pharmacy benefit manager maximum allowable cost pricing disclosed.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2014-03-26 - Author added Hamilton [HF1872 Detail]
Download: Minnesota-2013-HF1872-Engrossed.html
1.2relating to health; disclosing maximum allowable cost pricing used by pharmacy
1.3benefit managers;proposing coding for new law in Minnesota Statutes, chapter
1.4151.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. [151.71] MAXIMUM ALLOWABLE COST PRICING.
1.7 Subdivision 1. Definitions. (a) For purposes of this section, the following terms
1.8have the meanings given.
1.9(b) "Health plan company" has the meaning provided in section 62Q.01, subdivision
1.104.
1.11(c) "Pharmacy benefit manager" means an entity doing business in this state that
1.12contracts to administer or manage prescription drug benefits on behalf of any health plan
1.13company that provides prescription drug benefits to residents of this state.
1.14 Subd. 2. Pharmacy benefit manager contracts with pharmacies; maximum
1.15allowable cost pricing. (a) In each contract between a pharmacy benefit manager and
1.16a pharmacy, the pharmacy shall be given the right to obtain from the pharmacy benefit
1.17manager a current list of the sources used to determine maximum allowable cost pricing.
1.18The pharmacy benefit manager shall update the pricing information at least every seven
1.19business days and provide a means by which contracted pharmacies may promptly review
1.20current prices in an electronic, print, or telephonic format within one business day at no
1.21cost to the pharmacy. A pharmacy benefit manager shall maintain a procedure to eliminate
1.22products from the list of drugs subject to maximum allowable cost pricing in a timely
1.23manner in order to remain consistent with changes in the marketplace.
2.1(b) In order to place a prescription drug on a maximum allowable cost list, a
2.2pharmacy benefit manager shall ensure that the drug is generally available for purchase by
2.3pharmacies in this state from a national or regional wholesaler and is not obsolete.
2.4(c) Each contract between a pharmacy benefit manager and a pharmacy must include
2.5a process to appeal, investigate, and resolve disputes regarding maximum allowable cost
2.6pricing that includes:
2.7(1) a 15-business day limit on the right to appeal following the initial claim;
2.8(2) a requirement that the appeal be investigated and resolved within seven business
2.9days after the appeal; and
2.10(3) a requirement that a pharmacy benefit manager provide a reason for any appeal
2.11denial and identify the national drug code of a drug that may be purchased by the
2.12pharmacy at a price at or below the maximum allowable cost price as determined by
2.13the pharmacy benefit manager.
2.14(d) If the appeal is upheld, the pharmacy benefit manager shall make an adjustment
2.15to the maximum allowable cost price no later than one business day after the date of
2.16determination. The pharmacy benefit manager shall make the price adjustment applicable
2.17to all similarly situated network pharmacy providers as defined by the plan sponsor.
2.18EFFECTIVE DATE.This section is effective January 1, 2015.
1.3benefit managers;proposing coding for new law in Minnesota Statutes, chapter
1.4151.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. [151.71] MAXIMUM ALLOWABLE COST PRICING.
1.7 Subdivision 1. Definitions. (a) For purposes of this section, the following terms
1.8have the meanings given.
1.9(b) "Health plan company" has the meaning provided in section 62Q.01, subdivision
1.104.
1.11(c) "Pharmacy benefit manager" means an entity doing business in this state that
1.12contracts to administer or manage prescription drug benefits on behalf of any health plan
1.13company that provides prescription drug benefits to residents of this state.
1.14 Subd. 2. Pharmacy benefit manager contracts with pharmacies; maximum
1.15allowable cost pricing. (a) In each contract between a pharmacy benefit manager and
1.16a pharmacy, the pharmacy shall be given the right to obtain from the pharmacy benefit
1.17manager a current list of the sources used to determine maximum allowable cost pricing.
1.18The pharmacy benefit manager shall update the pricing information at least every seven
1.19business days and provide a means by which contracted pharmacies may promptly review
1.20current prices in an electronic, print, or telephonic format within one business day at no
1.21cost to the pharmacy. A pharmacy benefit manager shall maintain a procedure to eliminate
1.22products from the list of drugs subject to maximum allowable cost pricing in a timely
1.23manner in order to remain consistent with changes in the marketplace.
2.1(b) In order to place a prescription drug on a maximum allowable cost list, a
2.2pharmacy benefit manager shall ensure that the drug is generally available for purchase by
2.3pharmacies in this state from a national or regional wholesaler and is not obsolete.
2.4(c) Each contract between a pharmacy benefit manager and a pharmacy must include
2.5a process to appeal, investigate, and resolve disputes regarding maximum allowable cost
2.6pricing that includes:
2.7(1) a 15-business day limit on the right to appeal following the initial claim;
2.8(2) a requirement that the appeal be investigated and resolved within seven business
2.9days after the appeal; and
2.10(3) a requirement that a pharmacy benefit manager provide a reason for any appeal
2.11denial and identify the national drug code of a drug that may be purchased by the
2.12pharmacy at a price at or below the maximum allowable cost price as determined by
2.13the pharmacy benefit manager.
2.14(d) If the appeal is upheld, the pharmacy benefit manager shall make an adjustment
2.15to the maximum allowable cost price no later than one business day after the date of
2.16determination. The pharmacy benefit manager shall make the price adjustment applicable
2.17to all similarly situated network pharmacy providers as defined by the plan sponsor.
2.18EFFECTIVE DATE.This section is effective January 1, 2015.
