Minn. Stat. § 62W.01
Citation
This chapter may be cited as the "Minnesota Pharmacy Benefit Manager Licensure and Regulation Act."
Minnesota Statutes Chapter 62W — Minnesota Pharmacy Benefit Manager
Minnesota · statute · Minn. Stat. ch. 62W · 18 active provisions
Minn. Stat. § 62W.02
Definitions
Subdivision 1. Scope. For purposes of this chapter, the following terms have the meanings given. Subd. 2. Aggregate retained rebate. "Aggregate retained rebate" means the percentage of all rebates received by a pharmacy benefit manager from a drug manufacturer for drug utilization that is not passed on to the pharmacy…
Minn. Stat. § 62W.03
License to Do Business
Subdivision 1. General. (a) Beginning January 1, 2020, no person shall perform, act, or do business in this state as a pharmacy benefit manager unless the person has a valid license issued under this chapter by the commissioner of commerce. (b) A license issued in accordance with this chapter is nontransferable. Subd.…
Minn. Stat. § 62W.04
Pharmacy Benefit Manager General Business Practices
(a) A pharmacy benefit manager must exercise good faith and fair dealing in the performance of its contractual duties. A provision in a contract between a pharmacy benefit manager and a health carrier or a network pharmacy that attempts to waive or limit this obligation is void. (b) A pharmacy benefit manager must noti…
Minn. Stat. § 62W.05
Pharmacy Benefit Manager Network Adequacy
Subdivision 1. Requirements. (a) A pharmacy benefit manager must provide an adequate and accessible pharmacy network for the provision of prescription drugs that meet the relevant requirements in section 62K.10. Mail order pharmacies must not be included in the calculations of determining the adequacy of the pharmacy b…
Minn. Stat. § 62W.06
Pharmacy Benefit Manager Transparency
Subdivision 1. Transparency to plan sponsors. (a) Beginning in the second quarter after the effective date of a contract between a pharmacy benefit manager and a plan sponsor, the pharmacy benefit manager must disclose, upon the request of the plan sponsor, the following information with respect to prescription drug be…
Minn. Stat. § 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 sp…
Minn. Stat. § 62W.075
Therapeutic Alternative Prescription Drug
A pharmacy benefit manager or health carrier must not require, or demonstrate a preference for, a pharmacy to dispense a therapeutically equivalent or therapeutically alternative drug that costs the enrollee more out-of-pocket than the prescribed drug, unless the substitution is made for medical reasons that benefit th…
Minn. Stat. § 62W.076
Specialty Pharmacy
A pharmacy benefit manager that contracts with a specialty pharmacy must disclose to an enrollee, upon request, the enrollee's out-of-pocket costs at the specialty pharmacy for the prescription drug referenced by the enrollee and the enrollee's out-of-pocket cost at a network retail pharmacy that is identified by the e…
Minn. Stat. § 62W.077
Preferred Network
A pharmacy benefit manager that uses a preferred network of pharmacies must disclose to an enrollee upon request the enrollee's out-of-pocket cost at the preferred pharmacy for the prescription drug referenced by the enrollee and the enrollee's out-of-pocket cost at a nonpreferred pharmacy identified by the enrollee th…
Minn. Stat. § 62W.08
Maximum Allowable Cost Pricing
(a) With respect to each contract and contract renewal between a pharmacy benefit manager and a pharmacy, the pharmacy benefits manager must: (1) provide to the pharmacy, at the beginning of each contract and contract renewal, the sources utilized to determine the maximum allowable cost pricing of the pharmacy benefit…
Minn. Stat. § 62W.09
Pharmacy Audits
Subdivision 1. Procedure and process for conducting and reporting an audit. (a) Unless otherwise prohibited by federal requirements or regulations, any entity conducting a pharmacy audit must follow the following procedures: (1) a pharmacy must be given notice 14 days before an initial on-site audit is conducted; (2) a…
Minn. Stat. § 62W.10
Synchronization
(a) For purposes of this section, "synchronization" means the coordination of prescription drug refills for a patient taking two or more medications for one or more chronic conditions, to allow the patient's medications to be refilled on the same schedule for a given period of time. (b) A contract between a pharmacy be…
Minn. Stat. § 62W.11
Gag Clause Prohibition
(a) No contract between a pharmacy benefit manager or health carrier and a pharmacy or pharmacist shall prohibit, restrict, or penalize a pharmacy or pharmacist from disclosing to an enrollee any health care information that the pharmacy or pharmacist deems appropriate regarding the nature of treatment; the risks or al…
Minn. Stat. § 62W.12
Point of Sale
No pharmacy benefit manager or health carrier shall require an enrollee to make a payment at the point of sale for a covered prescription drug in an amount greater than the lesser of: (1) the applicable co-payment for the prescription drug; (2) the allowable claim amount for the prescription drug; or (3) the amount an…
Minn. Stat. § 62W.13
Retroactive Adjustments
No pharmacy benefit manager shall retroactively adjust a claim for reimbursement submitted by a pharmacy for a prescription drug, unless the adjustment is a result of a: (1) pharmacy audit conducted in accordance with section 62W.09; or (2) technical billing error.
Minn. Stat. § 62W.14
Prompt Filling for Specialty Drugs
(a) A health carrier or pharmacy benefit manager that requires or provides financial incentives for enrollees to use a mail order pharmacy to fill a prescription for a specialty drug must ensure through contract and other means that the mail order pharmacy dispenses the prescription drug to the enrollee in a timely man…
Minn. Stat. § 62W.15
Clinician-Administered Drugs
Subdivision 1. Definition. (a) For purposes of this section, the following definition applies. (b) "Clinician-administered drug" means an outpatient prescription drug other than a vaccine that: (1) cannot reasonably be self-administered by the enrollee to whom the drug is prescribed or by an individual assisting the en…