This bill (S.F. No. 2152) proposes an amendment to Minnesota Statutes 2024, section 256B.69, by adding a new subdivision that establishes a directed pharmacy dispensing payment aimed at improving and maintaining access to pharmaceutical services in rural and underserved areas.

Key Provisions:

1. Directed Payment Amount:

   • A payment of $4.50 per filled prescription will be provided to eligible outpatient retail pharmacies serving Medical Assistance (Medicaid) enrollees.
   • This payment must be in addition to any existing dispensing fees and cannot replace or reduce other pharmacy payments.

2. Eligibility Criteria for Pharmacies:

   • The pharmacy must be licensed in Minnesota and not owned by a pharmacy benefit manager (PBM) or health insurer.
   • It must be located in a medically underserved area or primarily serve a medically underserved population, as defined by the U.S. Department of Health and Human Services.
   • Alternatively, it must have common ownership with no more than 12 pharmacies in Minnesota.

3. Funding and Administration:

   • The commissioner of human services has the authority to set and adjust the payment amount based on available state and federal funding.
   • Managed care and county-based purchasing plans, along with their contracted PBMs, must distribute these payments to eligible pharmacies.
   • The commissioner is responsible for monitoring the impact of this payment on pharmaceutical access in rural and underserved areas.

4. Federal Approval and Contingency Plan:

   • If federal approval for this initiative is not received, capitation rates paid to managed care plans will be adjusted accordingly.
   • Contracts between managed care plans, PBMs, and pharmacies must include provisions for potential payment recovery in case of funding adjustments.
   • The subdivision will expire if federal approval is not granted at any point.

Purpose:

The bill aims to sustain access to medications in rural and underserved communities by supplementing pharmacy dispensing fees, ensuring that small and independent pharmacies can continue to operate in these areas.

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