HF 348

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/15/2023 10:28am

A bill for an act
relating to insurance; limiting cost-sharing for prescription drugs and related
medical supplies to treat chronic disease; amending Minnesota Statutes 2022,
sections 256B.0631, subdivision 1; 256L.03, subdivision 5; proposing coding for
new law in Minnesota Statutes, chapter 62Q.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [62Q.481] COST-SHARING FOR PRESCRIPTION DRUGS AND
RELATED MEDICAL SUPPLIES TO TREAT CHRONIC DISEASE.
new text end

new text begin Subdivision 1. new text end

new text begin Cost-sharing limits. new text end

new text begin (a) A health plan must limit the amount of any
enrollee cost-sharing for prescription drugs prescribed to treat a chronic disease to no more
than $25 per one-month supply for each prescription drug regardless of the amount or type
of medication required to fill the prescription and to no more than $50 per month in total
for all related medical supplies. The cost-sharing limit for related medical supplies does not
increase with the number of chronic diseases for which an enrollee is treated. Coverage
under this section shall not be subject to any deductible.
new text end

new text begin (b) If application of this section before an enrollee has met their plan's deductible would
result in: (1) health savings account ineligibility under United States Code, title 26, section
223; or (2) catastrophic health plan ineligibility under United States Code, title 42, section
18022(e), then this section shall apply to that specific prescription drug or related medical
supply only after the enrollee has met their plan's deductible.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following definitions apply.
new text end

new text begin (b) "Chronic disease" means diabetes, asthma, and allergies requiring the use of
epinephrine auto-injectors.
new text end

new text begin (c) "Cost-sharing" means co-payments and coinsurance.
new text end

new text begin (d) "Related medical supplies" means syringes, insulin pens, insulin pumps, test strips,
glucometers, continuous glucose monitors, epinephrine auto-injectors, asthma inhalers, and
other medical supply items necessary to effectively and appropriately treat a chronic disease
or administer a prescription drug prescribed to treat a chronic disease.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, and applies to health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2022, section 256B.0631, subdivision 1, is amended to read:

Subdivision 1.

Cost-sharing.

(a) Except as provided in subdivision 2, the medical
assistance benefit plan shall include the following cost-sharing for all recipients deleted text begin , effective
for services provided on or after September 1, 2011 deleted text end :

(1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes of this
subdivision, a visit means an episode of service which is required because of a recipient's
symptoms, diagnosis, or established illness, and which is delivered in an ambulatory setting
by a physician or physician assistant, chiropractor, podiatrist, nurse midwife, advanced
practice nurse, audiologist, optician, or optometrist;

(2) $3.50 for nonemergency visits to a hospital-based emergency room, except that this
co-payment shall be increased to $20 upon federal approval;

(3) $3 per brand-name drug prescription, $1 per generic drug prescription, and $1 per
prescription for a brand-name multisource drug listed in preferred status on the preferred
drug list, subject to a $12 per month maximum for prescription drug co-payments. No
co-payments shall apply to antipsychotic drugs when used for the treatment of mental illness;

(4) a family deductible equal to $2.75 per month per family and adjusted annually by
the percentage increase in the medical care component of the CPI-U for the period of
September to September of the preceding calendar year, rounded to the next higher five-cent
increment; deleted text begin and
deleted text end

(5) total monthly cost-sharing must not exceed five percent of family income. For
purposes of this paragraph, family income is the total earned and unearned income of the
individual and the individual's spouse, if the spouse is enrolled in medical assistance and
also subject to the five percent limit on cost-sharing. This paragraph does not apply to
premiums charged to individuals described under section 256B.057, subdivision 9 deleted text begin . deleted text end new text begin ; and
new text end

new text begin (6) cost-sharing for prescription drugs and related medical supplies to treat chronic
disease must comply with the requirements of section 62Q.481.
new text end

(b) Recipients of medical assistance are responsible for all co-payments and deductibles
in this subdivision.

(c) Notwithstanding paragraph (b), the commissioner, through the contracting process
under sections 256B.69 and 256B.692, may allow managed care plans and county-based
purchasing plans to waive the family deductible under paragraph (a), clause (4). The value
of the family deductible shall not be included in the capitation payment to managed care
plans and county-based purchasing plans. Managed care plans and county-based purchasing
plans shall certify annually to the commissioner the dollar value of the family deductible.

(d) Notwithstanding paragraph (b), the commissioner may waive the collection of the
family deductible described under paragraph (a), clause (4), from individuals and allow
long-term care and waivered service providers to assume responsibility for payment.

(e) Notwithstanding paragraph (b), the commissioner, through the contracting process
under section 256B.0756 shall allow the pilot program in Hennepin County to waive
co-payments. The value of the co-payments shall not be included in the capitation payment
amount to the integrated health care delivery networks under the pilot program.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
new text end

Sec. 3.

Minnesota Statutes 2022, section 256L.03, subdivision 5, is amended to read:

Subd. 5.

Cost-sharing.

(a) Co-payments, coinsurance, and deductibles do not apply to
children under the age of 21 and to American Indians as defined in Code of Federal
Regulations, title 42, section 600.5.

(b) The commissioner shall adjust co-payments, coinsurance, and deductibles for covered
services in a manner sufficient to maintain the actuarial value of the benefit to 94 percent.
The cost-sharing changes described in this paragraph do not apply to eligible recipients or
services exempt from cost-sharing under state law. The cost-sharing changes described in
this paragraph shall not be implemented prior to January 1, 2016.

(c) The cost-sharing changes authorized under paragraph (b) must satisfy the requirements
for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations,
title 42, sections 600.510 and 600.520.

new text begin (d) Cost-sharing for prescription drugs and related medical supplies to treat chronic
disease must comply with the requirements of section 62Q.481.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024.
new text end