SF 1530 requires health plan companies and pharmacy benefit managers to permit enrollees a choice of pharmacy providers and requires health plan companies to cover services that are performed by pharmacists if the service is a covered service, within the scope of the practice of the pharmacist, and would be covered if another provider performed the service. 

Section 1 (62Q.83) permits enrollees of a health plan company (HPC) or pharmacy benefit manager to choose where they obtain their pharmacy services.

Subd. 1 prohibits a HPC or PBM from limiting or restricting an enrollee’s ability to select a pharmacy or pharmacist of the enrollee’s choice if the pharmacy or pharmacist is licensed in the state and the pharmacy or pharmacist has agreed to the terms of the HPC or PBM provider contract.  Specifies that this subdivision does not apply to an enrollee in the Minnesota restricted recipient program.

Subd. 2 prohibits a HPC or PBM from denying a pharmacy or pharmacist the right to participate in its pharmacy network contracts if the pharmacy or pharmacist has a valid license in their state and agrees to accept the terms and conditions  offered by the HPC or PBM and meets all state and federal laws and regulations.

Subd. 3 prohibits a HPC or PBM from imposing a cost-sharing requirement or other fee on an enrollee for selecting a pharmacy or pharmacist or impose conditions that limit or restrict an enrollee’s choice unless the same cost-sharing, fees, limits, or conditions are imposed on an enrollee’s selection of any pharmacy within the provider network contracts.

Subd. 4 defines pharmacy and pharmacy benefit manager.

Section 2 (62Q.84) requires a HPC or PBM to provide payment for any health care service that is a covered benefit and provided by a licensed pharmacist if the service performed is within the scope of practice of the licensed pharmacist and the service would be covered if the service was performed by a physician, advanced practice registered nurse or physician assistant.