1 | 1 | | 1.1 A bill for an act |
---|
2 | 2 | | 1.2 relating to health care; requiring that an enrollee receive any rebates and discounts |
---|
3 | 3 | | 1.3 accrued directly or indirectly to health carriers; proposing coding for new law in |
---|
4 | 4 | | 1.4 Minnesota Statutes, chapter 62A. |
---|
5 | 5 | | 1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: |
---|
6 | 6 | | 1.6 Section 1. [62A.3096] COST-SHARING REDUCTIONS AT POINT OF SALE. |
---|
7 | 7 | | 1.7 Subdivision 1.Definitions.(a) For purposes of this section, the following terms have |
---|
8 | 8 | | 1.8the meanings given. |
---|
9 | 9 | | 1.9 (b) "Defined cost-sharing" means a deductible or coinsurance amount imposed on an |
---|
10 | 10 | | 1.10enrollee for a covered prescription drug under the terms of the enrollee's health plan. |
---|
11 | 11 | | 1.11 (c) "Health carrier" has the meaning given in section 62A.011, subdivision 2. Health |
---|
12 | 12 | | 1.12carrier includes a pharmacy benefit manager as defined in section 62W.02, subdivision 15, |
---|
13 | 13 | | 1.13with respect to the pharmacy benefit management services provided on behalf of a health |
---|
14 | 14 | | 1.14carrier. |
---|
15 | 15 | | 1.15 (d) "Price protection rebate" means a negotiated price concession that accrues directly |
---|
16 | 16 | | 1.16or indirectly to the health carrier, or other party on behalf of the health carrier, in the event |
---|
17 | 17 | | 1.17the wholesale acquisition cost of a drug increases above a specified threshold. |
---|
18 | 18 | | 1.18 (e) "Rebate" means: |
---|
19 | 19 | | 1.19 (1) negotiated price concessions, including but not limited to base price concessions, |
---|
20 | 20 | | 1.20whether described as a rebate or otherwise, and reasonable estimates of any price protection |
---|
21 | 21 | | 1.21rebates and performance-based price concessions that may accrue directly or indirectly to |
---|
22 | 22 | | 1Section 1. |
---|
23 | 23 | | 25-02751 as introduced02/07/25 REVISOR RSI/AC |
---|
24 | 24 | | SENATE |
---|
25 | 25 | | STATE OF MINNESOTA |
---|
26 | 26 | | S.F. No. 2176NINETY-FOURTH SESSION |
---|
27 | 27 | | (SENATE AUTHORS: NELSON) |
---|
28 | 28 | | OFFICIAL STATUSD-PGDATE |
---|
29 | 29 | | Introduction and first reading03/06/2025 |
---|
30 | 30 | | Referred to Commerce and Consumer Protection 2.1the health carrier during the coverage year from a manufacturer, dispensing pharmacy, or |
---|
31 | 31 | | 2.2other party in connection with dispensing or administering a prescription drug; and |
---|
32 | 32 | | 2.3 (2) reasonable estimates of any negotiated prices, concessions, fees, and other |
---|
33 | 33 | | 2.4administrative costs that are passed through to the health carrier and serve to reduce the |
---|
34 | 34 | | 2.5health carrier's liabilities for a prescription drug. |
---|
35 | 35 | | 2.6 Subd. 2.Decrease in cost-sharing.(a) An enrollee's defined cost-sharing for each |
---|
36 | 36 | | 2.7prescription drug must be calculated at the point of sale based on a price that is reduced by |
---|
37 | 37 | | 2.8an amount equal to 100 percent of all rebates received or to be received in connection with |
---|
38 | 38 | | 2.9dispensing or administering the prescription drug. |
---|
39 | 39 | | 2.10 (b) Nothing in this section precludes a health carrier from decreasing an enrollee's defined |
---|
40 | 40 | | 2.11cost-sharing by an amount greater than is required under this subdivision. |
---|
41 | 41 | | 2.12 Subd. 3.Confidentiality.(a) When complying with this section, a health carrier or the |
---|
42 | 42 | | 2.13health carrier's agents must not publish or otherwise reveal information regarding the actual |
---|
43 | 43 | | 2.14amount of rebates a health carrier receives on a product, therapeutic class of products, |
---|
44 | 44 | | 2.15manufacturer-specific basis, or pharmacy-specific basis. |
---|
45 | 45 | | 2.16 (b) Rebate information is protected as a trade secret, is not a public record under chapter |
---|
46 | 46 | | 2.1713, and must not be disclosed: |
---|
47 | 47 | | 2.18 (1) directly; |
---|
48 | 48 | | 2.19 (2) indirectly; |
---|
49 | 49 | | 2.20 (3) in a manner that may identify an individual product, therapeutic class of products, |
---|
50 | 50 | | 2.21or manufacturer; or |
---|
51 | 51 | | 2.22 (4) in a manner that has the potential to compromise the financial, competitive, or |
---|
52 | 52 | | 2.23proprietary nature of the information. |
---|
53 | 53 | | 2.24 (c) A health carrier must impose the confidentiality protections of this section on any |
---|
54 | 54 | | 2.25vendor or downstream third party that performs health care or administrative services on |
---|
55 | 55 | | 2.26behalf of the health carrier that may receive or have access to rebate information. |
---|
56 | 56 | | 2.27 Subd. 4.Enforcement.A health carrier or pharmacy benefit manager that fails to comply |
---|
57 | 57 | | 2.28with this section may be subject to sanctions under the appropriate chapters regulating the |
---|
58 | 58 | | 2.29health carrier or pharmacy benefit manager, including civil penalties and suspension or |
---|
59 | 59 | | 2.30revocation of the health carrier's or pharmacy benefit manager's license. |
---|
60 | 60 | | 2Section 1. |
---|
61 | 61 | | 25-02751 as introduced02/07/25 REVISOR RSI/AC |
---|