MN HF5470

Establishes definitions for pharmacy acquisition cost (amount wholesaler charges as listed on pharmacy invoice), pharmaceutical wholesaler, and spread pricing (model where PBM charges plan sponsor different price than what pharmacy receives).

Prohibits pharmacy benefit managers from charging pharmacies adjudication-related fees, requiring accreditation standards beyond board of pharmacy requirements, and conducting spread pricing.

Requires PBMs to reimburse independent pharmacies at rates no less than affiliate/subsidiary pharmacies on a per-unit basis using the same generic product identifier.

Modifies maximum allowable cost pricing to require updates within seven calendar days of 10% or more acquisition cost increases from 60% or more of state wholesalers, mandates disclosure of pricing sources, and establishes 30-business-day appeal process with 7-business-day investigation requirement.

Restricts retroactive claim adjustments to cases involving fraudulent claims, duplicate payments, or improperly rendered services, and permits pharmacies to decline filling prescriptions if reimbursement falls below their acquisition cost.