Plain English Breakdown
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HF4140 • 2026
Minnesota Community Pharmacy Patient Access and Fair Reimbursement Act established, and rulemaking required.
Minnesota Community Pharmacy Patient Access and Fair Reimbursement Act established, and rulemaking required.
Passed Legislature
This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.
Bill History
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2026-03-09
House
Introduction and first reading, referred to Health Finance and Policy
Official Summary Text
Minnesota Community Pharmacy Patient Access and Fair Reimbursement Act established, and rulemaking required.
Current Bill Text
Read the full stored bill text
A bill for an act relating to health; establishing the Minnesota Community Pharmacy Patient Access and Fair Reimbursement Act; requiring rulemaking; proposing coding for new law in Minnesota Statutes, chapter 62J. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: Section 1. new text begin [62J.901] MINNESOTA COMMUNITY PHARMACY PATIENT ACCESS AND FAIR REIMBURSEMENT ACT. new text end new text begin Subdivision 1. new text end new text begin Title. new text end new text begin This section shall be known as the "Minnesota Community Pharmacy Patient Access and Fair Reimbursement Act." new text end new text begin Subd. 2. new text end new text begin Scope. new text end new text begin This section is intended to protect patients' access to community pharmacies by ensuring sustainable reimbursement rates for community pharmacies and to prevent unfair reimbursement practices that cause pharmacy closures, thereby safeguarding patient access to essential pharmaceutical care and maintaining a strong community health infrastructure across the state. This section regulates pharmacy benefit manager conduct and reimbursement practices and does not alter health plan benefit design or federal program requirements. new text end new text begin Subd. 3. new text end new text begin Definitions. new text end new text begin (a) For purposes of this section, the following terms have the meanings given. new text end new text begin (b) "Community pharmacy" means an outpatient retail pharmacy licensed under chapter 151 that is not owned, operated, managed, or controlled, either directly or indirectly, through an affiliate or subsidiary by a: new text end new text begin (1) pharmacy benefit manager licensed under chapter 62W; new text end new text begin (2) health carrier, as defined in section 62A.011, subdivision 2; new text end new text begin (3) government entity; new text end new text begin (4) mail-order pharmacy; or new text end new text begin (5) specialty pharmacy. new text end new text begin (c) "National Average Drug Acquisition Cost" or "NADAC" means the publicly available, federally established benchmark reflecting the average acquisition cost of outpatient prescription drugs purchased by retail community pharmacies, as determined by the Centers for Medicare and Medicaid Services. new text end new text begin (d) "Pharmacy benefit manager" or "PBM" has the meaning given in section 62W.02, subdivision 15. new text end new text begin (e) "Pharmacy reimbursement ceiling" means the maximum reimbursement rate for prescription drugs dispensed by a pharmacy established under subdivision 4. new text end new text begin (f) "Professional dispensing fee" means the fee paid to a pharmacy for the cost of dispensing a medication, excluding the cost of the drug itself. The fee is intended to cover the professional services provided by the pharmacy dispensing the medication, in accordance with section 256B.0625, subdivision 13e. new text end new text begin (g) "Wholesale acquisition cost" or "WAC" means the manufacturer's list price for a prescription drug to wholesalers or direct purchasers in the United States, not including any discounts, rebates, or other price concessions. new text end new text begin Subd. 4. new text end new text begin Fair pharmacy reimbursement. new text end new text begin (a) Except as provided in paragraph (c), this subdivision applies to prescription drugs dispensed by a community pharmacy, as defined in subdivision 3, and to claims adjudicated by a PBM under a health plan or pharmacy benefit plan. new text end new text begin (b) To improve patient access to pharmacy services and support the financial viability of community pharmacies, for any prescription drug dispensed by a community pharmacy and for any claim adjudicated by a PBM to which this subdivision applies, the total reimbursement to the community pharmacy must be equal to: new text end new text begin (1) the NADAC for the drug on the day of claim adjudication or, if the NADAC is unavailable, the WAC for that drug on the day of claim adjudication, plus an additional amount equal to four percent of the calculated total ingredient cost as derived from the applicable NADAC or WAC amount, or $50, whichever is less; and new text end new text begin (2) a professional dispensing fee as specified in section 256B.0625, subdivision 13e, which must be equal to the professional dispensing fee paid by the state under the medical assistance program and adjusted biennially based on an independent cost-of-dispensing survey reflecting inflation, labor costs, and operational expenses. new text end new text begin (c) The reimbursement standard established in this subdivision constitutes both the minimum and maximum reimbursement amount for purposes of this section and may not be altered by contract, network design, or other reimbursement methodology. new text end new text begin Subd. 5. new text end new text begin Scope of application; covered entities; exclusions. new text end new text begin (a) Nothing in this section requires reimbursement at or above NADAC or WAC for drugs purchased under the federal 340B Drug Pricing Program. Reimbursement for drugs purchased under the 340B program must comply with applicable state and federal law. new text end new text begin (b) This section does not apply to claims paid under Medicare or Medicaid, including claims paid under Medicare Part B, Medicare Part D, and Medicaid fee-for-service or managed care, or under any other state or federal program for which reimbursement is established by statute, regulation, state plan, contract approved by a federal agency, or federal waiver. new text end new text begin (c) This section regulates the reimbursement practices of pharmacy benefit managers licensed under chapter 62W with respect to claims paid under commercial health plans and pharmacy benefit plans subject to state regulation. new text end new text begin Subd. 6. new text end new text begin Prohibition on below-cost and postclaim manipulation. new text end new text begin (a) A PBM must not reimburse a community pharmacy in an amount below the reimbursement standard established in this section. new text end new text begin (b) A PBM must not impose any fee, adjustment, recoupment, reconciliation payment, performance metric, direct or indirect remuneration fee, or other mechanism that results in a community pharmacy receiving less than the total reimbursement required under this section. new text end new text begin Subd. 7. new text end new text begin Ban on spread pricing. new text end new text begin PBMs are prohibited from engaging in spread pricing in commercial and state-regulated plans. A PBM may not retain any portion of payments made by a health plan, insurer, government program, or other payer beyond the amount paid to the dispensing pharmacy, less enrollee cost sharing. PBMs must remit to the dispensing pharmacy 100 percent of payments received, less patient cost-sharing. new text end new text begin Subd. 8. new text end new text begin Prohibition of retroactive claim denials. new text end new text begin PBMs must not retroactively deny or reduce claim reimbursement except in cases of fraud, billing errors, or documented overpayment verified through an audit. new text end new text begin Subd. 9. new text end new text begin Prohibition on patient steering. new text end new text begin PBMs must not require, coerce, steer, or financially penalize an enrollee to use a PBM-owned, affiliated, or mail-order pharmacy. A PBM must not impose higher cost-sharing, reduced benefits, or other financial or administrative disadvantages on an enrollee who chooses to obtain prescription drugs from a community pharmacy. new text end new text begin Subd. 10. new text end new text begin Enforcement and penalties. new text end new text begin (a) The Department of Commerce has exclusive authority to administer and enforce this section. new text end new text begin (b) A community pharmacy, health carrier, plan sponsor, or enrollee may file a complaint with the commissioner alleging a violation of this section. The commissioner shall investigate alleged violations and may require the submission of claims data, pricing files, contracts, and any other records necessary to determine compliance. new text end new text begin (c) To ensure compliance with this section, the commissioner may: new text end new text begin (1) conduct investigations and compel the production of unredacted records, pricing agreements, claims data, contracts, and internal communications relevant to reimbursement practices; new text end new text begin (2) order corrective action including restitution, cease-and-desist orders, and prospective pricing adjustments to remedy and prevent violations; new text end new text begin (3) require annual compliance certification from PBMs attesting to full compliance with this section. A false certification is subject to civil penalties and potential suspension of licensure; and new text end new text begin (4) publish an annual compliance report summarizing: new text end new text begin (i) the number of violations identified; new text end new text begin (ii) the amount of fines and restitution collected; and new text end new text begin (iii) the impact on community pharmacy access and closures. new text end new text begin (d) A PBM found to be reimbursing below the reimbursement standard established in subdivision 4 is subject to a civil penalty of $5,000 per violation per claim. Repeat violations are subject to escalating penalties of up to $20,000 per claim, not to exceed $2,000,000 per enforcement action. The Department of Commerce may impose additional sanctions, including suspension or revocation of a PBM's license to operate in the state. new text end new text begin (e) If the commissioner determines that a PBM has violated this section, the commissioner may: new text end new text begin (1) order full restitution to the affected pharmacy, including interest and reasonable costs incurred in the administrative proceeding; and new text end new text begin (2) impose any additional sanctions authorized under this section. new text end new text begin (f) A pharmacist or other individual who, in good faith, reports noncompliance, fraudulent reimbursement practices, or retaliatory conduct by a PBM is protected from retaliation. The commissioner shall establish a secure and confidential process for receiving reports. Verified violations may result in additional penalties or corrective action. new text end new text begin (g) A final order of the commissioner is subject to judicial review under chapter 14. new text end new text begin Subd. 11. new text end new text begin Rulemaking. new text end new text begin The commissioner of commerce shall adopt necessary rules to implement this section. new text end new text begin Subd. 12. new text end new text begin Severability. new text end new text begin If any provision of this section or its application to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the section that can be given effect without the invalid provision or application. new text end new text begin EFFECTIVE DATE. new text end new text begin This section is effective July 1, 2026. new text end