HF 4582

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/24/2022 01:59pm

A bill for an act
relating to health care; prohibiting prior authorization for prescription drugs
prescribed for the treatment of mental illness in the medical assistance and
MinnesotaCare programs; amending Minnesota Statutes 2020, section 256B.0625,
subdivisions 13f, 13j.

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

Section 1.

Minnesota Statutes 2020, section 256B.0625, subdivision 13f, is amended to
read:

Subd. 13f.

Prior authorization.

(a) The Formulary Committee shall review and
recommend drugs which require prior authorization. The Formulary Committee shall
establish general criteria to be used for the prior authorization of brand-name drugs for
which generically equivalent drugs are available, but the committee is not required to review
each brand-name drug for which a generically equivalent drug is available.

(b) Prior authorization may be required by the commissioner before certain formulary
drugs are eligible for payment. The Formulary Committee may recommend drugs for prior
authorization directly to the commissioner. The commissioner may also request that the
Formulary Committee review a drug for prior authorization. Before the commissioner may
require prior authorization for a drug:

(1) the commissioner must provide information to the Formulary Committee on the
impact that placing the drug on prior authorization may have on the quality of patient care
and on program costs, information regarding whether the drug is subject to clinical abuse
or misuse, and relevant data from the state Medicaid program if such data is available;

(2) the Formulary Committee must review the drug, taking into account medical and
clinical data and the information provided by the commissioner; and

(3) the Formulary Committee must hold a public forum and receive public comment for
an additional 15 days.

The commissioner must provide a 15-day notice period before implementing the prior
authorization.

(c) deleted text begin Except as provided in subdivision 13j, deleted text end Prior authorization shall not be required or
utilized for any deleted text begin atypical antipsychotic deleted text end drug prescribed for the treatment of mental illness new text begin
as defined in section 245.462, subdivision 20, new text end if deleted text begin : deleted text end new text begin the drug prescribed is approved by the
United States Food and Drug Administration for the treatment of mental illness.
new text end

deleted text begin (1) there is no generically equivalent drug available; and
deleted text end

deleted text begin (2) the drug was initially prescribed for the recipient prior to July 1, 2003; or
deleted text end

deleted text begin (3) the drug is part of the recipient's current course of treatment.
deleted text end

This paragraph applies to any deleted text begin multistate deleted text end preferred drug list or supplemental drug rebate
program established or administered by the commissioner. deleted text begin Prior authorization shall
automatically be granted for 60 days for brand name drugs prescribed for treatment of mental
illness within 60 days of when a generically equivalent drug becomes available, provided
that the brand name drug was part of the recipient's course of treatment at the time the
generically equivalent drug became available.
deleted text end

(d) new text begin Except as specified in paragraph (c), new text end the commissioner may require prior authorization
for brand name drugs whenever a generically equivalent product is available, even if the
prescriber specifically indicates "dispense as written-brand necessary" on the prescription
as required by section 151.21, subdivision 2.

(e) Notwithstanding this subdivision, the commissioner may automatically require prior
authorization, for a period not to exceed 180 days, for any drug that is approved by the
United States Food and Drug Administration on or after July 1, 2005. The 180-day period
begins no later than the first day that a drug is available for shipment to pharmacies within
the state. The Formulary Committee shall recommend to the commissioner general criteria
to be used for the prior authorization of the drugs, but the committee is not required to
review each individual drug. In order to continue prior authorizations for a drug after the
180-day period has expired, the commissioner must follow the provisions of this subdivision.

(f) Prior authorization under this subdivision shall comply with section 62Q.184.

(g) Any step therapy protocol requirements established by the commissioner must comply
with section 62Q.1841.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2023.
new text end

Sec. 2.

Minnesota Statutes 2020, section 256B.0625, subdivision 13j, is amended to read:

Subd. 13j.

Antipsychotic and attention deficit disorder and attention deficit
hyperactivity disorder medications.

(a) The commissioner, in consultation with the Drug
Utilization Review Board established in subdivision 13i and actively practicing pediatric
mental health professionals, must:

(1) identify recommended pediatric dose ranges for atypical antipsychotic drugs and
drugs used for attention deficit disorder or attention deficit hyperactivity disorder based on
available medical, clinical, and safety data and research. The commissioner shall periodically
review the list of medications and pediatric dose ranges and update the medications and
doses listed as needed after consultation with the Drug Utilization Review Board;

(2) identify situations where a collaborative psychiatric consultation and prior
authorization should be required before the initiation or continuation of drug therapy in
pediatric patients including, but not limited to, high-dose regimens, off-label use of
prescription medication, a patient's young age, and lack of coordination among multiple
prescribing providers; and

(3) track prescriptive practices and the use of psychotropic medications in children with
the goal of reducing the use of medication, where appropriate.

(b) deleted text begin Effective July 1, 2011, deleted text end The commissioner shall require deleted text begin prior authorization and deleted text end a
collaborative psychiatric consultation before an atypical antipsychotic and attention deficit
disorder and attention deficit hyperactivity disorder medication meeting the criteria identified
in paragraph (a), clause (2), is eligible for payment. A collaborative psychiatric consultation
must be completed before the identified medications are eligible for payment unless:

(1) the patient has already been stabilized on the medication regimen; or

(2) the prescriber indicates that the child is in crisis.

If clause (1) or (2) applies, the collaborative psychiatric consultation must be completed
within 90 days for payment to continue.

(c) For purposes of this subdivision, a collaborative psychiatric consultation must meet
the criteria described in section 245.4862, subdivision 4.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2023.
new text end