§ 62W.05 — Pharmacy Benefit Manager Network Adequacy
Plain-Language Summary
This section sets out duties and obligations that licensed PBMs must follow. It covers transparency requirements and standards for dealing with pharmacies and health plans.
62W.05 PHARMACY BENEFIT MANAGER NETWORK ADEQUACY.
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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 pharmacies must not be included in the calculations of determining the adequacy of the pharmacy benefit manager’s pharmacy network under section 62K.10.
(b) A pharmacy benefit manager must submit to the commissioner a pharmacy network adequacy report describing the pharmacy network and pharmacy accessibility in this state, with the pharmacy benefit manager’s license application and renewal, in a manner prescribed by the commissioner. §
Subd. 2.Network adequacy waiver.
A pharmacy benefit manager may apply for a waiver from the commissioner of health if the pharmacy benefit manager is unable to meet the network adequacy requirements under subdivision 1. A waiver application must be submitted to the commissioner of health on a form prescribed by the commissioner of health and must:
(1) demonstrate with specific data why the pharmacy benefit manager is not able to meet the requirements; and
(2) include information as to the steps that were and will be taken to address network adequacy.
If a waiver is granted by the commissioner of health, the waiver shall automatically expire after three years. If a renewal of the waiver is sought, the commissioner of health shall consider steps that the pharmacy benefit manager has taken over the past three-year period to address network adequacy. §
Subd. 3.Accreditation standards.
A pharmacy benefit manager must not require pharmacy accreditation standards or recertification requirements to participate in a network that are inconsistent with, more stringent than, or in addition to federal and state requirements for licensure as a pharmacy in this state unless authorized under this chapter.
History:
History: History:
2019 c 39 s 5