SF2152

This bill (S.F. No. 2152) proposes an amendment to Minnesota Statutes 2024, section 256B.69, by adding a new subdivision to establish a Directed Pharmacy Dispensing Payment program. The purpose is to improve and maintain access to pharmaceutical services in rural and underserved areas of the state by providing an additional $4.50 per filled prescription to eligible outpatient retail pharmacies.

Key Provisions:

1. Eligibility for Payment:

   • The payment applies to eligible outpatient retail pharmacies in Minnesota.
   • Pharmacies must be licensed under chapter 151 and must not be owned by a pharmacy benefit manager (PBM) or health carrier.
   • The pharmacy must either:
     • Be located in a medically underserved area or primarily serve a medically underserved population, as designated by the U.S. Department of Health and Human Services.
     • Share common ownership with 12 or fewer Minnesota pharmacies.

2. Payment Administration:

   • Managed care and county-based purchasing plans, as well as PBMs under contract with these entities, must pay the additional $4.50 per prescription for drugs dispensed to Medical Assistance enrollees.
   • The payment must not replace or reduce any other dispensing fee currently paid.
   • Entities making these payments cannot offset them by reducing other payments to pharmacies.

3. Verification Process:

   • Pharmacies must submit a form to the commissioner of human services attesting to their eligibility.

4. Funding Adjustments:

   • The commissioner has the authority to set and adjust the payment amount based on available state and federal funding.
   • If federal approval is not received for the directed payment in a contract year, the capitation rates for managed care and county-based purchasing plans will be adjusted accordingly.
   • Contracts must allow recovery of payments from providers if capitation rates are adjusted.
   • If federal approval is permanently denied, the provision will expire.

Purpose:

This bill aims to preserve access to pharmacy services in rural and underserved areas, ensuring small and independent pharmacies can remain financially viable while serving Medical Assistance recipients.

Financial Implication:

The bill allocates state funding and leverages federal support, but the exact financial impact would depend on federal approval and state budget allocations.

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