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SF3299 (Legislative Session 94 (2025-2026))

Community pharmacy reimbursement fair pricing requirement provision

AI Generated Summary

Purpose of the Bill

The purpose of the bill is to ensure fair pricing in pharmacy reimbursements across Minnesota. It aims to improve patient access to pharmacy services and support the financial viability of community pharmacies by setting minimum reimbursement standards for prescription drugs they dispense.

Main Provisions

  1. Minimum Reimbursement Standards: For any prescription drug dispensed by a community pharmacy, the reimbursement must be at least equal to the National Average Drug Acquisition Cost (NADAC) or, if NADAC is unavailable, the Wholesale Acquisition Cost (WAC). Additionally, pharmacies should receive a professional dispensing fee, which is adjusted biennially based on an independent cost-of-dispensing survey.

  2. Exclusion for 340B Program: The bill clarifies that the reimbursement rates do not apply to drugs purchased under the federal 340B program. Reimbursement for these drugs will follow federal and state laws.

  3. Prohibition of Below-Cost Reimbursements: The bill bans reimbursements that are below cost as well as negative reimbursement adjustments for community pharmacies. It lists the following measures to ensure fairness:

    • Pharmacy Benefit Managers (PBMs) and Managed Care Organizations (MCOs) must meet the minimum reimbursement standards without applying reductions.
    • PBMs and MCOs cannot impose fees, such as transaction fees or other adjustments, that would reduce the pharmacy’s total reimbursement below the required standard.
    • PBMs cannot pay their own pharmacies more than community pharmacies for the same services.
    • Prohibition of any fees that could lower the net reimbursement to community pharmacies below the established minimum.

Significant Changes to Existing Law

  • The bill introduces a mandatory minimum reimbursement rate for community pharmacies that aligns with NADAC or WAC, along with a professional dispensing fee.
  • Establishes stringent regulations against any negative financial adjustments by PBMs and MCOs to ensure fair reimbursement and to protect community pharmacies from financial losses.
  • Enforces parity in reimbursement rates between community pharmacies and those owned by PBMs.

Relevant Terms

  • National Average Drug Acquisition Cost (NADAC)
  • Wholesale Acquisition Cost (WAC)
  • Pharmacy Benefit Managers (PBMs)
  • Managed Care Organizations (MCOs)
  • Community Pharmacies
  • Professional Dispensing Fee
  • 340B Program

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
April 06, 2025SenateFloorActionIntroduction and first reading
April 06, 2025SenateFloorActionReferred toHealth and Human Services
April 08, 2025SenateFloorActionAuthor added
April 09, 2025SenateFloorActionAuthor added

Citations

 
[
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This bill references the professional dispensing fee definition as outlined in section 256B.0625, subdivision 13e, as part of the fair pharmacy reimbursement formula.",
      "modified": []
    },
    "citation": "256B.0625",
    "subdivision": "subdivision 13e"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Reference to the 340B Drug Pricing Program as defined in the United States Code.",
      "modified": []
    },
    "citation": "42 U.S.C. section 256b",
    "subdivision": ""
  }
]

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