Pharmacy benefit manager requirement clarified.

A bill for an act

relating to state government; clarifying a pharmacy benefit manager requirement;

amending Minnesota Statutes 2024, section 43A.231, subdivision 5.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2024, section 43A.231, subdivision 5, is amended to read:

Subd. 5.

Report; savings determination; process for selecting successor pharmacy

benefit manager.

(a) The commissioner of management and budget, with the assistance of

an actuarial consultant, shall compare the following: (1) actual, electronically adjudicated

prescription drug costs under the first two years of the contract that begins on January 1,

2023, with a pharmacy benefit manager that was selected by the reverse auction; and (2) a

projection of what prescription drug costs would have been for those same two years under

the pharmacy benefit manager contract in effect from 2018 to 2022, with appropriate

adjustment for any adopted formulary or beneficiary utilization changes. The projection

must use industry-recognized data sources. The commissioner of management and budget

shall report the results of the comparison to the legislative auditor and to the chairs and

ranking minority members of the committees in the senate and house of representatives

with jurisdiction over state government finance and policy by March 1, 2025.

(b) The commissioner of management and budget must require the actuarial consultant

to take appropriate measures to ensure that the consultant's work is not compromised by a

conflict of interest.

(c) By April 1, 2025, the legislative auditor shall provide a report to the commissioner

of management and budget and to the chairs and ranking minority members of the committees

in the senate and house of representatives with jurisdiction over state government finance

and policy. The legislative auditor's report must make a determination as to whether the

commissioner's report accurately performs the comparison required under paragraph (a).

(d) The technology platform vendor shall provide to the commissioner of management

and budget and to the legislative auditor the electronically adjudicated prescription drug

data and any other support or assistance required by the commissioner of management and

budget to prepare a report and for the legislative auditor to validate the accuracy of the

commissioner's results of the comparison, by deadlines established by the commissioner of

management and budget and the legislative auditor. Individual-identifying data received

from the technology platform vendor is private data on individuals, as defined by section

13.02, subdivision 12
.

(e) If the commissioner of management and budget determines that savings on

prescription drug costs were not achieved, based on the comparison required under paragraph

(a), with appropriate adjustment for any adopted formulary or beneficiary utilization changes,

the commissioner may forego the use of a reverse auction for procurement of a successor

pharmacy benefit manager contract. If the commissioner of management and budget

determines that savings have been achieved, the commissioner must select the successor

pharmacy benefit manager contract using the reverse auction process described in this

section. If the commissioner's comparison in paragraph (a) finds that savings are not achieved,

the commissioner's report under paragraph (a) must include the commissioner's findings

that support a determination that savings were not achieved, analysis of the factors that

caused a failure to achieve savings, and recommendations for how savings could be achieved

in the next contract with a pharmacy benefit manager.
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If the commissioner's comparison in

paragraph (a) is inconclusive, the commissioner may forego the use of a reverse auction for

procurement of a successor pharmacy benefit manager contract.
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