MN HF728

Creates new state licensure and regulatory framework for pharmacy benefit managers (PBMs) effective January 1, 2020, administered by the Commissioner of Commerce with $3,000 application fee and $1,000,000 financial responsibility requirement.

Establishes fiduciary duties for PBMs to health carriers and requires transparent disclosure of rebates, fees, and pricing information to both plan sponsors and the Commissioner in annual reports.

Implements detailed pharmacy audit standards including 14-day notice requirement, prohibition on audits during first five business days of month, 24-month lookback period, and ban on extrapolation in recoupment calculations.

Prohibits "gag clauses" restricting pharmacies from disclosing pricing information to patients and requires PBMs to allow prescription synchronization at least once annually for maintenance medications meeting specified criteria.

Regulates maximum allowable cost (MAC) pricing with requirements for weekly updates, appeals process with 15-business-day appeal window and 7-business-day resolution period, and prohibition on MAC pricing for drugs unavailable from national/regional wholesalers.