| 1 | 1 | | 1.1 A bill for an act |
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| 2 | 2 | | 1.2 relating to human services; requiring the commissioner of human services to |
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| 3 | 3 | | 1.3 establish a directed pharmacy dispensing payment to improve and maintain access |
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| 4 | 4 | | 1.4 to pharmaceutical services; appropriating money; amending Minnesota Statutes |
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| 5 | 5 | | 1.5 2024, section 256B.69, by adding a subdivision. |
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| 6 | 6 | | 1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: |
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| 7 | 7 | | 1.7 Section 1. Minnesota Statutes 2024, section 256B.69, is amended by adding a subdivision |
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| 8 | 8 | | 1.8to read: |
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| 9 | 9 | | 1.9 Subd. 6i.Directed pharmacy dispensing payment.(a) The commissioner shall provide |
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| 10 | 10 | | 1.10a directed pharmacy dispensing payment of $4.50 per filled prescription to eligible outpatient |
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| 11 | 11 | | 1.11retail pharmacies in Minnesota to improve and maintain access to pharmaceutical services |
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| 12 | 12 | | 1.12in rural and underserved areas of the state. Managed care and county-based purchasing |
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| 13 | 13 | | 1.13plans delivering services under sections 256B.69 or 256B.692, and any pharmacy benefit |
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| 14 | 14 | | 1.14managers under contract with these entities, must pay the directed pharmacy dispensing |
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| 15 | 15 | | 1.15payment to eligible outpatient retail pharmacies for drugs dispensed to medical assistance |
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| 16 | 16 | | 1.16enrollees. The directed pharmacy dispensing payment is in addition to, and must not supplant |
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| 17 | 17 | | 1.17or reduce, any other dispensing fee paid by these entities to the pharmacy. Entities paying |
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| 18 | 18 | | 1.18the directed pharmacy dispensing payment must not reduce other payments to the pharmacy |
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| 19 | 19 | | 1.19as a result of payment of the directed pharmacy dispensing payment. |
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| 20 | 20 | | 1.20 (b) For purposes of this subdivision, "eligible outpatient retail pharmacy" means an |
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| 21 | 21 | | 1.21outpatient retail pharmacy licensed under chapter 151 that is not owned, either directly or |
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| 22 | 22 | | 1.22indirectly or through an affiliate or subsidiary, by a pharmacy benefit manager licensed |
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| 23 | 23 | | 1.23under chapter 62W or a health carrier, as defined in section 62A.011, subdivision 2, and |
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| 24 | 24 | | 1.24that: |
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| 25 | 25 | | 1Section 1. |
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| 26 | 26 | | REVISOR AGW/DG 25-0145912/16/24 |
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| 27 | 27 | | State of Minnesota |
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| 28 | 28 | | This Document can be made available |
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| 29 | 29 | | in alternative formats upon request |
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| 30 | 30 | | HOUSE OF REPRESENTATIVES |
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| 31 | 31 | | H. F. No. 1100 |
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| 32 | 32 | | NINETY-FOURTH SESSION |
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| 33 | 33 | | Authored by Bahner, Backer, Bierman, Nadeau, Reyer and others02/19/2025 |
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| 34 | 34 | | The bill was read for the first time and referred to the Committee on Health Finance and Policy 2.1 (1) is located in a medically underserved area or primarily serves a medically underserved |
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| 35 | 35 | | 2.2population, as defined by the United States Department of Health and Human Services |
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| 36 | 36 | | 2.3Health Resources and Services Administration under United States Code, title 42, section |
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| 37 | 37 | | 2.4254; or |
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| 38 | 38 | | 2.5 (2) shares common ownership with 12 or fewer Minnesota pharmacies. |
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| 39 | 39 | | 2.6 (c) In order to receive the directed pharmacy dispensing payment, a pharmacy must |
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| 40 | 40 | | 2.7submit to the commissioner a form, developed by the commissioner, attesting that the |
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| 41 | 41 | | 2.8pharmacy meets the requirements of paragraph (b). |
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| 42 | 42 | | 2.9 (d) The commissioner shall set and adjust the amount of the directed pharmacy dispensing |
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| 43 | 43 | | 2.10payment to reflect the available state and federal funding. |
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| 44 | 44 | | 2.11 (e) Managed care and county-based purchasing plans, and any pharmacy benefit managers |
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| 45 | 45 | | 2.12under contract with these entities, shall pay the directed pharmacy dispensing payment to |
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| 46 | 46 | | 2.13eligible outpatient retail pharmacies. The commissioner shall monitor the effect of this |
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| 47 | 47 | | 2.14requirement on access to pharmaceutical services in rural and underserved areas of the state. |
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| 48 | 48 | | 2.15If, for any contract year, federal approval is not received for this subdivision, the |
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| 49 | 49 | | 2.16commissioner must adjust the capitation rates paid to managed care plans and county-based |
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| 50 | 50 | | 2.17purchasing plans for that contract year to reflect removal of this subdivision. Contracts |
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| 51 | 51 | | 2.18between managed care plans and county-based purchasing plans, and any pharmacy benefit |
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| 52 | 52 | | 2.19managers under contract with these entities, and providers to whom this subdivision applies, |
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| 53 | 53 | | 2.20must allow recovery of payments from those providers if capitation rates are adjusted in |
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| 54 | 54 | | 2.21accordance with this paragraph. Payment recoveries must not exceed the amount equal to |
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| 55 | 55 | | 2.22any increase in rates that results from this subdivision. This subdivision expires if federal |
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| 56 | 56 | | 2.23approval is not received for this subdivision at any time. |
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| 57 | 57 | | 2.24 EFFECTIVE DATE.This section is effective July 1, 2025, or upon federal approval, |
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| 58 | 58 | | 2.25whichever is later. The commissioner of human services shall notify the revisor of statutes |
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| 59 | 59 | | 2.26when federal approval is obtained. |
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| 60 | 60 | | 2.27 Sec. 2. APPROPRIATION. |
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| 61 | 61 | | 2.28 $....... in fiscal year 2026 and $....... in fiscal year 2027 are appropriated from the general |
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| 62 | 62 | | 2.29fund to the commissioner of human services to provide directed pharmacy dispensing |
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| 63 | 63 | | 2.30payments under Minnesota Statutes, section 256B.69, subdivision 6i. |
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| 64 | 64 | | 2Sec. 2. |
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| 65 | 65 | | REVISOR AGW/DG 25-0145912/16/24 |
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