Licensing
The law requires PBMs contracting with plan sponsors doing business in Minnesota to be actively licensed. Licenses are required to be renewed each year. The law also outlines requirements for licensure and sets standards for penalties for performing PBM services without a license. More information on the initial licensing and renewal processes is available on the Insurance Licensing page of the Commerce website.
Transparency reporting
The law also established transparency reporting requirements for PBMs. By June 1 of each year, all licensed PBMs must submit some form of response to Commerce regarding their reporting status for the previous plan year. All qualifying PBMs are required to submit their prescription drug reports by the same deadline. Commerce requires PBMs to use the Aggregate, Claims Level Detail, and Public Report templates when there is applicable data to submit (more information is available in the table below). The Department will not publish any data considered to be trade secret or outside the scope of Minn. Stat. §62W.06, subd. 2.
The two templates must also be used when reporting zero data to the Department. If a PBM has determined it does not have reporting responsibilities, each template should be completed as a “zero report,” and accompanied by a brief justification to the Department.
Below is a list of scenarios and corresponding explanations for transparency or zero reports:
Scenario |
Report Type(s) Requires |
Additional Information Required |
PBM contracts with plan sponsors doing business in MN and has reportable data under Minn. Stat. §62W.06, subd. 2 |
Aggregate Report
Claims Level Detail Report
Public Report
|
none |
PBM contracts with plan sponsors doing business in MN and has no reportable data under Minn. Stat. §62W.06, subd. 2 |
Zero Aggregate Report
Zero Claims Level Details Report |
Detailed rationale for submission of Zero Reports |
PBM contracts with plan sponsors doing business in MN and has partial reportable data under Minn. Stat. §62W.06, subd. 2 |
Zero Aggregate Report/Aggregate Report
Zero Claims Level Details Report/Claims Level Detail Report
Public Report |
Detailed rationale for submission of Zero Reports |
Additional information regarding PBM transparency reporting for plan year 2021 will be available on this page in Spring 2022.