This week, the General Assembly passed SF 6/HF2, including pharmacy’s language to restructure the Medicaid managed care pharmacy benefit under a state-directed, non-conflicted, transparent single PBM, like the Ohio and Kentucky models. The Department is required to implement the model by January 1, 2027, which mandates an AAC (National Average Drug Acquisition Cost or Minnesota actual acquisition cost) + $11.55 Professional Dispensing Fee (PDF) payment rate. The bill also includes a $4.50 “directed payment” to supplement current PDFs through the end of 2026. To qualify, the pharmacy must attest to having less than 13 locations, or be in a federally designated medically underserved area, or primarily serve an underserved population. Lastly, the bill also extends audio-only telehealth allowances to providers through Fiscal Year 2027; this applies to reimbursements for claims with private plans, Medicaid and MinnesotaCare. Many thanks to our members and pharmacy partners, especially the Minnesota Retailers’ Association and the Minnesota Pharmacy Alliance, for taking the lobbying lead on-the-ground in St. Paul. NACDS will update members when Gov. Tim Walz (D) signs the bill and when the Department provides guidance on applying for the “directed payment” supplement.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.