Title Minnesota Statutes, Minnesota Statutes

62W.05 PHARMACY BENEFIT MANAGER NETWORK ADEQUACY. § Subdivision 1.Requirements. (a) A pharmacy benefit manager must provide an adequate and accessible pharmacy network for the provision of prescription drugs that meet the relevant requirements in section 62K.10. Mail order pharma…

62W.06 PHARMACY BENEFIT MANAGER TRANSPARENCY. § Subdivision 1.Transparency to plan sponsors. (a) Beginning in the second quarter after the effective date of a contract between a pharmacy benefit manager and a plan sponsor, the pharmacy benefit manager must disclose, upon the requ…

62W.07 PHARMACY OWNERSHIP INTEREST; PHARMACY SERVICES. (a) A pharmacy benefit manager that has an ownership interest either directly or indirectly, or through an affiliate or subsidiary, in a pharmacy must disclose to a plan sponsor that contracts with the pharmacy benefit manage…

62W.075 THERAPEUTIC ALTERNATIVE PRESCRIPTION DRUG. A pharmacy benefit manager or health carrier must not require, or demonstrate a preference for, a pharmacy to dispense a therapeutically equivalent or therapeutically alternative drug that costs the enrollee more out-of-pocket th…

62W.076 SPECIALTY PHARMACY. A pharmacy benefit manager that contracts with a specialty pharmacy must disclose to an enrollee, upon request, the enrollee's out-of-pocket costs at the specialty pharmacy for the prescription drug referenced by the enrollee and the enrollee's out-of-…

62W.077 PREFERRED NETWORK. A pharmacy benefit manager that uses a preferred network of pharmacies must disclose to an enrollee upon request the enrollee's out-of-pocket cost at the preferred pharmacy for the prescription drug referenced by the enrollee and the enrollee's out-of-p…

62W.08 MAXIMUM ALLOWABLE COST PRICING. (a) With respect to each contract and contract renewal between a pharmacy benefit manager and a pharmacy, the pharmacy benefits manager must: (1) provide to the pharmacy, at the beginning of each contract and contract renewal, the sources ut…

62W.09 PHARMACY AUDITS. § Subdivision 1.Procedure and process for conducting and reporting an audit. (a) Unless otherwise prohibited by federal requirements or regulations, any entity conducting a pharmacy audit must follow the following procedures: (1) a pharmacy must be given n…

62W.10 SYNCHRONIZATION. (a) For purposes of this section, "synchronization" means the coordination of prescription drug refills for a patient taking two or more medications for one or more chronic conditions, to allow the patient's medications to be refilled on the same schedule …

62W.11 GAG CLAUSE PROHIBITION. (a) No contract between a pharmacy benefit manager or health carrier and a pharmacy or pharmacist shall prohibit, restrict, or penalize a pharmacy or pharmacist from disclosing to an enrollee any health care information that the pharmacy or pharmaci…

62W.12 POINT OF SALE. No pharmacy benefit manager or health carrier shall require an enrollee to make a payment at the point of sale for a covered prescription drug in an amount greater than the lesser of: (1) the applicable co-payment for the prescription drug; (2) the allowable…

62W.13 RETROACTIVE ADJUSTMENTS. No pharmacy benefit manager shall retroactively adjust a claim for reimbursement submitted by a pharmacy for a prescription drug, unless the adjustment is a result of a: (1) pharmacy audit conducted in accordance with section 62W.09; or (2) technic…

62W.14 PROMPT FILLING FOR SPECIALTY DRUGS. (a) A health carrier or pharmacy benefit manager that requires or provides financial incentives for enrollees to use a mail order pharmacy to fill a prescription for a specialty drug must ensure through contract and other means that the …

62W.15 CLINICIAN-ADMINISTERED DRUGS. § Subdivision 1.Definition. (a) For purposes of this section, the following definition applies. (b) "Clinician-administered drug" means an outpatient prescription drug other than a vaccine that: (1) cannot reasonably be self-administered by th…