MN SF2284

Board of Pharmacy shall designate specialty drugs in consultation with the commissioner of human services, considering factors like treatment of complex chronic conditions, special handling requirements, and need for patient monitoring; designated list published every six months in State Register.

Pharmacy benefit managers may only designate drugs as specialty drugs if on the Board's published list and must allow any contracted licensed pharmacy meeting capability requirements to fill specialty drug prescriptions at the specialty pharmacy rate with equal reimbursement.

Pharmacy benefit managers must permit covered individuals to fill prescriptions at either mail-order pharmacies or retail community pharmacies at substantially the same price, with equal pricing benchmarks, indices, formulas, and drug codes regardless of pharmacy type.

Pharmacy benefit managers cannot use maximum allowable cost pricing until after six-month generic exclusivity period and only if three or more nationally available therapeutically equivalent drugs exist; must remove drugs from pricing index if this criterion cannot be met.

Pharmacy benefit managers must disclose maximum allowable cost pricing methodology at year beginning and update pricing index at least every seven business days; establish procedure for pharmacies to contest rates with 15-day response requirement.

Pharmacy benefit managers must notify health plan sponsors 30 days before selling, leasing, or renting utilization or claims data and obtain written approval; cannot transmit personally identifiable patient data to pharmacy benefit manager-owned pharmacies without written patient election.