HF4373 (Legislative Session 94 (2025-2026))
Changes to provisions covering prescription drug prior authorizations, transactions with group purchasers, prescription drug price transparency, health maintenance organizations, network design, coverage for immunizations, access to certain data collected, and obsolete language made.
Related bill: SF4419
AI Generated Summary
Purpose
- Modernize and streamline how prescription drug decisions get approved and paid for.
- Increase price transparency and public information about prescription drugs.
- Move many paper and fax processes to secure electronic systems.
- Update who must report price and usage data and how that data is collected and shared.
What the bill changes in health insurance and drug pricing
- Prescription drug prior authorization (PA) moves to electronic, standardized transmissions between providers and group purchasers.
- By 2027, all PA requests between providers and group purchasers must be exchanged electronically using a national standard (NCPDP SCRIPT), with other electronic data interchange standards preferred where available.
- Facsimile (fax) transmissions are not considered electronic transmissions for PA purposes.
- Some group purchasers not covered by HIPAA may have flexible requirements or exemptions, and the rules include a system to review exemptions and, if appropriate, adopt new rules.
- The bill adds many precise definitions to align terminology around drugs, pricing, and transactions (e.g., brand name drug, generic drug, biosimilar, NDC, wholesale acquisition cost, patient assistance programs, pricing units, etc.).
Key provisions and what they aim to accomplish
- Electronic drug prior authorization standardization (Article 1, Section 1)
- The state asks for an outline by 2010, then a standard companion guide by 2014 for how providers and group purchasers exchange PA requests electronically.
- By 2016, PA requests must be accessible and submitted electronically (secure transmissions); fax not allowed.
- By 2027, PA requests must be exchanged electronically using the NCPDP SCRIPT Standard.
- Group purchasers and HIPAA (Article 1, Section 2)
- For group purchasers not covered by HIPAA, there are specific allowances and exemptions related to electronic transactions and eligibility exchanges.
- If certain electronic requirements can’t be met, exemptions may be granted and rules may be adjusted over time.
- Definitions and scope (Article 1, Section 3)
- Adds formal definitions for terms used throughout the bill, including biosimilars, brand name and generic drugs, patient assistance programs, price, 30-day supply, course of treatment, NDC, PBM, pricing unit, rebates, reporting entities, and more.
- Sets terminology around what counts as a drug, its price, and how transactions are described.
- Prescription drug price increases reporting (Article 1, Section 4)
- Starting from specific dates, manufacturers must report price increases for certain drugs when the increase meets thresholds.
- Thresholds:
- Brand name drugs: 10% increase within 12 months or 16% within 24 months.
- Generic or biosimilar drugs: 50% increase within 12 months.
- Also applies to drugs priced at $100+ for a 30-day supply or for a short course.
- Data to report includes drug description, NDC, product name, dosage form/strength/package size, factors causing the increase, competition (existing generics), introduction year, historical price data, costs to manufacture/market/distribute, units sold, revenues, rebates, net profit, patient assistance, any deals delaying generics, patent expiration, and international price comparisons (top 10 non-US countries).
- If a drug is acquired, acquisition price and related details must be reported.
- Substantial public interest pricing data (Article 1, Sections 5-6)
- The Department of Health will publish a list of drugs deemed to have substantial public interest and for which data will be requested.
- The list may include up to 500 drugs at a time.
- The list is published quarterly, and reporting entities are notified at least 30 days after posting.
- Manufacturer reporting for substantial public interest drugs (Article 1, Section 6)
- Manufacturers must report similar drug-specific data within 60 days of notification, including prices, costs, sales, rebates, profits, patient assistance, patent status, and international price comparisons.
- Pharmacy reporting for substantial public interest drugs (Article 1, Section 7)
- Pharmacies must report data for drugs on the substantial public interest list: pricing units acquired and dispensed, total costs before rebates, rebates, payments received, and average cash price, among other details.
- Small or independent pharmacies may be granted extensions or exemptions if compliance would be a hardship.
- PBM reporting for substantial public interest drugs (Article 1, Section 8)
- Pharmacy Benefit Managers must report pricing and reimbursement data, rebates, administrators’ fees, and related arrangements for drugs on the list.
- Wholesale drug distributor reporting for substantial public interest drugs (Article 1, Section 9)
- Wholesale distributors that moved drugs into the state (not the manufacturer) must report similar data, including units acquired and sold, costs, rebates, and revenues.
What this means in practice
- Hospitals, clinics, pharmacies, PBMs, and wholesalers will have more detailed data-reporting duties about drug prices, costs, rebates, and sales for drugs identified as of substantial public interest.
- There will be a formal process to publish a list of drugs that must be reported and to notify reporting entities about when to report.
- The state intends to use this information to improve transparency around drug pricing and the factors that drive price changes.
Implementation and timelines
- Electronic PA standardization and adoption timelines (2010–2027 milestones noted in the bill).
- Implementation of reporting requirements for manufacturers, pharmacies, PBMs, and wholesalers generally follows the notification-to-report process, with 60 days to report after notice.
- Small/independent pharmacies may obtain exemptions or extensions for pharmacy reporting.
- The bill includes annual reviews of certain exemptions and rulemaking processes to ensure alignment with national transaction standards.
Repeals and amendments
- The proposal repeals or amends certain existing statutes related to prior authorizations, price reporting, and related health data provisions, signaling a broad update to how drug transactions and price data are handled.
Who is affected
- Health care providers (prescribers and others who submit PA requests)
- Group purchasers
- Pharmacies (including independent and small pharmacies)
- Pharmacy Benefit Managers (PBMs)
- Wholesale drug distributors
- Drug manufacturers, including brand-name and generic/biosimilar products
- State agencies responsible for health data and price transparency
Overall effect
- The bill aims to modernize drug prior authorization, standardize and accelerate electronic data exchanges, and significantly increase price transparency by requiring detailed disclosure of price movements and related data for drugs deemed of substantial public interest.
Relevant Terms - prescription drug prior authorization - electronic drug prior authorization - electronic transmissions - secure electronic transmissions - facsimile (fax) - NCPDP SCRIPT Standard - group purchasers - HIPAA - health care claims - eligibility information - biosimilar - brand name drug - generic drug - patient assistance program - wholesale acquisition cost (WAC) - national drug code (NDC) - pricing unit - rebate - reporting entity - PBM (pharmacy benefit manager) - wholesale drug distributor - substantial public interest - reporting period - notice to report - transactions companion guides - uniform standard companion guides - price transparency - price increase reporting - acquisition price - international prices (top ten non-US countries)
Bill text versions
- Introduction PDF PDF file
Actions
| Date | Chamber | Where | Type | Name | Committee Name |
|---|---|---|---|---|---|
| March 16, 2026 | House | Action | Introduction and first reading, referred to | Commerce Finance and Policy |
Citations
[
{
"analysis": {
"added": [],
"removed": [],
"summary": "Repeal of Minnesota Statutes 2024 section 13D.08 subdivision 4 as part of the bill's repeal provisions.",
"modified": []
},
"citation": "13D.08",
"subdivision": "subdivision 4"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amendment to Minnesota Statutes 2024 section 60D.15 subdivision 3 referenced by the bill.",
"modified": []
},
"citation": "60D.15",
"subdivision": "subdivision 3"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amendment to Minnesota Statutes 2024 section 60D.21 subdivision 1 as part of the bill.",
"modified": []
},
"citation": "60D.21",
"subdivision": "subdivision 1"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amendment to Minnesota Statutes 2024 section 60D.21 subdivision 3 as part of the bill.",
"modified": []
},
"citation": "60D.21",
"subdivision": "subdivision 3"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Reference to Minnesota Statutes 2024 section 60D.23 in the bill (no subdivision specified).",
"modified": []
},
"citation": "60D.23",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "By adding a subdivision to 62D.02, affecting health-related provisions.",
"modified": []
},
"citation": "62D.02",
"subdivision": "subdivision 7"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "By adding subdivisions to 62D.08, related to exemptions/transactions.",
"modified": []
},
"citation": "62D.08",
"subdivision": "subdivision 5"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "By adding subdivisions to 62D.08, related to exemptions/transactions.",
"modified": []
},
"citation": "62D.08",
"subdivision": "subdivision 6"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "By adding subdivisions to 62D.09, related to exemptions/transactions.",
"modified": []
},
"citation": "62D.09",
"subdivision": "subdivision 1"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "By adding subdivisions to 62D.09, related to exemptions/transactions.",
"modified": []
},
"citation": "62D.09",
"subdivision": "subdivision 5"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "By adding subdivision 62D.124 subdivision 6, related to exemptions/transactions.",
"modified": []
},
"citation": "62D.124",
"subdivision": "subdivision 6"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "By adding subdivision 62D.221 subdivision 1, related to exemptions/transactions.",
"modified": []
},
"citation": "62D.221",
"subdivision": "subdivision 1"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amendment to 62J.17 subdivision 6a as part of the bill.",
"modified": []
},
"citation": "62J.17",
"subdivision": "subdivision 6a"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amendment to 62J.2930 subdivision 1 as part of the bill.",
"modified": []
},
"citation": "62J.2930",
"subdivision": "subdivision 1"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amendment to 62J.2930 subdivision 4 as part of the bill.",
"modified": []
},
"citation": "62J.2930",
"subdivision": "subdivision 4"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amends Minnesota Statutes 2024 section 62J.497 subdivision 5 establishing electronic drug prior authorization standardization and transmission.",
"modified": []
},
"citation": "62J.497",
"subdivision": "subdivision 5"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amends Minnesota Statutes 2024 section 62J.536 subdivision 2a regarding electronic health transactions with group purchasers.",
"modified": []
},
"citation": "62J.536",
"subdivision": "subdivision 2a"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amends Minnesota Statutes 2024 section 62K.02 subdivision 2 related to PBMs and pricing data.",
"modified": []
},
"citation": "62K.02",
"subdivision": "subdivision 2"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amends Minnesota Statutes 2024 section 62K.03 subdivision 6 related to PBMs.",
"modified": []
},
"citation": "62K.03",
"subdivision": "subdivision 6"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amendment to Minnesota Statutes 2024 section 62K.075 (no subdivision specified).",
"modified": []
},
"citation": "62K.075",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amendment to Minnesota Statutes 2024 section 62K.105 (no subdivision specified).",
"modified": []
},
"citation": "62K.105",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amendment to Minnesota Statutes 2024 section 62K.14 (no subdivision specified).",
"modified": []
},
"citation": "62K.14",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amends Minnesota Statutes 2024 section 62M.07 subdivision 2 regarding pricing and reporting for PBMs.",
"modified": []
},
"citation": "62M.07",
"subdivision": "subdivision 2"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amends Minnesota Statutes 2024 section 62Q.46 subdivision 1—reporting of prescription drug data.",
"modified": []
},
"citation": "62Q.46",
"subdivision": "subdivision 1"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amends Minnesota Statutes 2024 section 62U.04 subdivision 13 (data submission related to pricing/public interest).",
"modified": []
},
"citation": "62U.04",
"subdivision": "subdivision 13"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amends Minnesota Statutes 2024 section 62W.06 by adding a subdivision (new data reporting related to drugs).",
"modified": []
},
"citation": "62W.06",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Adds a new subdivision 144.293 subdivision 7 (drug pricing/public interest reporting expansion).",
"modified": []
},
"citation": "144.293",
"subdivision": "subdivision 7"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Minnesota Statutes 2025 Supplement section 3.732 subdivision 1 cited for cross-reference in the bill.",
"modified": []
},
"citation": "3.732",
"subdivision": "subdivision 1"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Definition for reporting entities added/amended in 62J.84 subdivision 2.",
"modified": []
},
"citation": "62J.84",
"subdivision": "subdivision 2"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Prescription drug price reporting framework amended in 62J.84 subdivision 3.",
"modified": []
},
"citation": "62J.84",
"subdivision": "subdivision 3"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Notice of prescription drugs of substantial public interest and reporting requirements (62J.84 subdivision 10).",
"modified": []
},
"citation": "62J.84",
"subdivision": "subdivision 10"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Manufacturer prescription drug substantial public interest reporting (62J.84 subdivision 11).",
"modified": []
},
"citation": "62J.84",
"subdivision": "subdivision 11"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Pharmacy prescription drug substantial public interest reporting (62J.84 subdivision 12).",
"modified": []
},
"citation": "62J.84",
"subdivision": "subdivision 12"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "PBM prescription drug substantial public interest reporting (62J.84 subdivision 13).",
"modified": []
},
"citation": "62J.84",
"subdivision": "subdivision 13"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Wholesale drug distributor prescription drug substantial public interest reporting (62J.84 subdivision 14).",
"modified": []
},
"citation": "62J.84",
"subdivision": "subdivision 14"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Amends Minnesota Statutes 2025 Supplement section 62K.10 subdivision 2 (pricing data/reporting related to PBMs).",
"modified": []
},
"citation": "62K.10",
"subdivision": "subdivision 2"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Repeal/addition related to 62D.08 subdivision 7 as part of the bill's repeals.",
"modified": []
},
"citation": "62D.08",
"subdivision": "subdivision 7"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Repeal/modify 62D.181 referenced in the bill.",
"modified": []
},
"citation": "62D.181",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Repeal/modify 62J.06 referenced in the bill.",
"modified": []
},
"citation": "62J.06",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Repeal/modify 62J.156 referenced in the bill.",
"modified": []
},
"citation": "62J.156",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Repeal/modify 62J.2930 subdivision 4 as part of the bill's repeals.",
"modified": []
},
"citation": "62J.2930",
"subdivision": "subdivision 4"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Reference to 62J.57 with an appended 1.17 provision as part of the bill.",
"modified": []
},
"citation": "62J.57",
"subdivision": "1.17"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Federal regulatory framework for electronic health care transactions (subpart L).",
"modified": []
},
"citation": "Code of Federal Regulations title 45 part 162 subpart L",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Federal regulatory framework for electronic health care transactions (subpart K).",
"modified": []
},
"citation": "Code of Federal Regulations title 45 part 162 subpart K",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Reference to the federal biosimilars/statutory framework (42 U.S.C. § 262k).",
"modified": []
},
"citation": "42 U.S.C. § 262K",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Reference to U.S. Code governing new drug applications (21 U.S.C. § 355c).",
"modified": []
},
"citation": "21 U.S.C. § 355c",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Reference to Medicare Part D pricing provisions (as cited in the bill text).",
"modified": []
},
"citation": "42 U.S.C. § 1395w-3ac6B",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "HIPAA-related electronic data exchange provisions (transition to standards).",
"modified": []
},
"citation": "42 U.S.C. § 1320d-2 to 1320d-8",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "HIPAA-related data exchange provisions (cross-reference).",
"modified": []
},
"citation": "42 U.S.C. § 1320d-2",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Code of Federal Regulations referenced relating to bona fide service fees under PBMs.",
"modified": []
},
"citation": "447.502",
"subdivision": ""
}
]Progress through the legislative process
In Committee