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MN HF4140
Bill
Status
3/9/2026
Primary Sponsor
Liz Reyer
Click for details
AI Summary
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Establishes mandatory reimbursement formula for community pharmacies: National Average Drug Acquisition Cost (NADAC) plus 4% of ingredient cost (capped at $50), plus a professional dispensing fee equal to the state Medicaid rate, adjusted biennially
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Prohibits pharmacy benefit managers (PBMs) from spread pricing, retroactive claim denials (except for fraud/billing errors), and patient steering toward PBM-owned or mail-order pharmacies
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Defines "community pharmacy" as independent retail pharmacies not owned by PBMs, health carriers, government entities, mail-order pharmacies, or specialty pharmacies
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Authorizes Department of Commerce enforcement with civil penalties of $5,000 per violation per claim, escalating to $20,000 for repeat violations, with a $2,000,000 cap per enforcement action, plus potential license suspension or revocation
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Effective July 1, 2026; applies only to commercial and state-regulated health plans, excluding Medicare, Medicaid, and federal 340B Drug Pricing Program claims
Legislative Description
Minnesota Community Pharmacy Patient Access and Fair Reimbursement Act established, and rulemaking required.
Last Action
Introduction and first reading, referred to Health Finance and Policy
3/9/2026