MN HF2851

Prohibits pharmacy benefit managers (PBMs) from engaging in "spread pricing," defined as charging health plans a different price for prescription drugs than what they pay pharmacies

Increases PBM license application and renewal fees from $8,500 to a minimum of $15,000, and late fees from $500 to a minimum of $1,000, with penalties for operating without a license raised from $5,000 to a minimum of $10,000 per day

Imposes fiduciary duties on PBMs toward health carriers, requiring them to act with care, skill, prudence, diligence, and professionalism, and prohibits charging pharmacies claim adjudication fees

Establishes new pharmacy reimbursement protections, requiring PBMs to pay pharmacies at least the national average drug acquisition cost and prohibiting reimbursement reductions through reconciliation processes or direct/indirect remuneration fees

Strengthens maximum allowable cost pricing requirements, including more frequent price list updates, expanded appeal rights for pharmacies, and allows pharmacies to decline dispensing if paid below acquisition cost