MN SF4062

Prohibits pharmacy benefit managers (PBMs) from engaging in spread pricing, where PBMs charge health plans more for drugs than they pay pharmacies, and bans PBMs from deriving income except through flat, defined pharmacy benefit management fees disclosed to health carriers

Imposes fiduciary duties on PBMs toward health carriers, requiring them to act with care, skill, prudence, and professionalism, and to disclose conflicts of interest in writing

Increases PBM license application and renewal fees from $8,500 to a range between $15,000 and an unspecified maximum, with late fees increasing from $500 to at least $1,000, and raises unlicensed operation penalties from $5,000/day to at least $10,000/day

Prohibits PBMs from charging pharmacies fees related to claim adjudication, reimbursing pharmacies below the national average drug acquisition cost, or reducing pharmacy payments through direct or indirect remuneration fees and reconciliation processes

Strengthens maximum allowable cost pricing requirements including mandatory updates within 7 days of significant price changes, expanded appeal processes for pharmacies, and allows pharmacies to decline to dispense drugs if reimbursement falls below acquisition cost