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.

The General Assembly will reconvene in a special session before July 1, due to missing the June 1 budget deadline. At that time, we expect them to consider pharmacy's priority issue, reforming the managed care pharmacy benefit under a state directed, transparent, pass-through single PBM. The new structure, similar to Ohio and Kentucky's, is included in both the Senate and House Health Omnibus bills (HF 2435/SF 2669). If adopted, pharmacy reimbursement would be set at Actual Acquisition Cost (AAC) + the current fee-for-service professional dispensing fee. NACDS played a key role in advocating for this structure and successfully secured support from the Administration and Department of Health and Human Services. 

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

As the General Assembly enters its last week of the session, both the House and Senate have passed our priority PBM reform language in their respective health omnibus bills, HF 2435 and SF 2669. The bills are now on their way to conference committee to hammer out differences. (HF 2435/SF 2669). The provisions would reform the Medicaid pharmacy program under a single state-directed pharmacy benefit administrator. The bills require a rate floor of AAC + $11.55 and include prohibitions on questionable PBM business practices. Also included is a provision changing the cost of dispensing study frequency from every three years to biannually.  

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Department of Health (MDH) published the March 2025 list of drugs of substantial public interest with a focus on insulin products. It is the second list published as part of the statutory reporting requirement. You can also find it on MDH’s Public Interest Drug Lists webpage along with the Public Interest List Methodology & Summary—March 2025. Reporting entities, including pharmacies, have approximately 90 days to report (notifications will be sent 30 or more days after the list release date; reports are due 60 days after notifications are sent). Data and analysis from this and other Lists of Drugs of Substantial Public Interest will be made available on the Prescription Drug Price Transparency website. For direct updates, subscribe to the Prescription Drug Price Transparency email list. For more information, visit the Prescription Drug Price Transparency website.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

A deal was reached this week to end the partisan stalemate in the Minnesota House of Representatives. The stalemate resulted when the November election left Republicans holding a one-vote majority by virtue of an open seat in a strongly Democratic district. The Democratic candidate is expected to easily win the seat in the March 11 special election and tie the House 67-67. In the interim, Democrats boycotted session, leaving Republicans without the quorum required to conduct business. The deal gives Rep. Leader Lisa Demuth (R) the Speakership through 2026 and her party control of committees until the special election. Following the election, the parties will share power by co-chairing the committees. 

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Department of Health released the first-ever state mandated financial report on the 340B Drug Pricing Program. As a follow up, Drug Channels published an article summarizing the report’s highlights.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Prescription Drug Affordability Board has posted the agenda for its November 26, 2024, meeting.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

NACDS reminds members that the new Medicaid Management Information System (MMIS) for pharmacy claims is scheduled to be implemented on November 4. For more information, see the Medical Assistance Portal.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

DHS has published a  provider update with details about the November 4^th transition to the new claims processing system.  On October 16 they will host what they anticipate will be the last provider virtual meeting prior to implementation and have posted the call in information. Lastly, they have also released the payer specification document for claims processing and billing.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.