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SF3299 (Legislative Session 94 (2025-2026))

Community pharmacy reimbursement fair pricing requirement provision

AI Generated Summary

Purpose of the Bill

The purpose of this bill is to ensure fair pricing for community pharmacies in Minnesota when they are reimbursed for dispensing prescription drugs. It aims to improve patient access to pharmacy services and support the financial stability of community pharmacies.

Main Provisions

  • Minimum Reimbursement Standards: The bill requires that community pharmacies be reimbursed at least the National Average Drug Acquisition Cost (NADAC) for any prescription, or if NADAC is unavailable, the Wholesale Acquisition Cost (WAC). This includes a professional dispensing fee which is adjusted every two years based on an independent survey of dispensing costs.
  • Prohibition of Below-Cost Reimbursements: Below-cost reimbursements and any negative adjustments for community pharmacies are prohibited. Specifically, pharmacy benefit managers (PBMs) and managed care organizations (MCOs) must reimburse pharmacies at or above these minimum standards.
  • No Negative Reimbursement Adjustments: PBMs and MCOs are not allowed to impose fees or adjustments that would otherwise reduce pharmacy reimbursements below these standards.
  • Parity in Reimbursement: The bill ensures that community pharmacies are reimbursed at rates comparable to PBM-owned or affiliated pharmacies for the same conditions, prohibiting higher reimbursement rates for PBM-owned entities.
  • Restriction on Fees: Direct or indirect fees that would reduce community pharmacy net reimbursement are prohibited.

Significant Changes

  • The bill introduces a new standard in Minnesota law requiring fair and consistent reimbursement practices for community pharmacies, ensuring they are not paid below cost for prescriptions.
  • It restricts PBMs and MCOs from using fees or adjustments that undermine the financial viability of community pharmacies.
  • Guarantees equal treatment in reimbursement between independent community pharmacies and PBM-owned or affiliated ones.

Relevant Terms

  • Fair pricing
  • Community pharmacies
  • Reimbursement standards
  • National Average Drug Acquisition Cost (NADAC)
  • Wholesale Acquisition Cost (WAC)
  • Professional dispensing fee
  • Pharmacy Benefit Managers (PBMs)
  • Managed Care Organizations (MCOs)
  • Independent cost-of-dispensing survey
  • 340B program

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
April 06, 2025SenateFloorActionIntroduction and first reading
April 06, 2025SenateFloorActionReferred toHealth and Human Services

Citations

 
[
  {
    "analysis": {
      "added": [
        "Clarifies reimbursement rules for community pharmacies."
      ],
      "removed": [],
      "summary": "This bill refers to the definition of a professional dispensing fee related to pharmacy reimbursement.",
      "modified": [
        "Adjusts professional dispensing fee calculation based on independent surveys."
      ]
    },
    "citation": "256B.0625",
    "subdivision": "subdivision 13e"
  },
  {
    "analysis": {
      "added": [
        "Ensures 340B program is not required to reimburse at NADAC or WAC rates."
      ],
      "removed": [],
      "summary": "This references the federal 340B Drug Pricing Program, providing guidance for pharmacy reimbursement.",
      "modified": [
        "Guidelines for determining reimbursement for 340B-purchased drugs."
      ]
    },
    "citation": "42 USC 256b",
    "subdivision": ""
  }
]

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