SF 1739

Introduction - 94th Legislature (2025 - 2026)

Posted on 02/25/2025 09:08 a.m.

A bill for an act
relating to health; establishing a prior authorization commission; directing the
commissioner of health to approve a medication for prohibition from prior
authorization; requiring a report; amending Minnesota Statutes 2024, section
62M.07, subdivision 2, by adding subdivisions.

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

Section 1.

Minnesota Statutes 2024, section 62M.07, subdivision 2, is amended to read:

Subd. 2.

Prior authorization of certain services prohibited.

No utilization review
organization, health plan company, or claims administrator may conduct or require prior
authorization of:

(1) emergency confinement or an emergency service. The enrollee or the enrollee's
authorized representative may be required to notify the health plan company, claims
administrator, or utilization review organization as soon as reasonably possible after the
beginning of the emergency confinement or emergency service;

(2) outpatient mental health treatment or outpatient substance use disorder treatment,
except for treatment which is a medication. Prior authorizations required for medications
used for outpatient mental health treatment or outpatient substance use disorder treatment
must be processed according to section 62M.05, subdivision 3b, for initial determinations,
and according to section 62M.06, subdivision 2, for appeals;

(3) antineoplastic cancer treatment that is consistent with guidelines of the National
Comprehensive Cancer Network, except for treatment which is a medication. Prior
authorizations required for medications used for antineoplastic cancer treatment must be
processed according to section 62M.05, subdivision 3b, for initial determinations, and
according to section 62M.06, subdivision 2, for appeals;

(4) services that currently have a rating of A or B from the United States Preventive
Services Task Force, immunizations recommended by the Advisory Committee on
Immunization Practices of the Centers for Disease Control and Prevention, or preventive
services and screenings provided to women as described in Code of Federal Regulations,
title 45, section 147.130;

(5) pediatric hospice services provided by a hospice provider licensed under sections
144A.75 to 144A.755; deleted text begin and
deleted text end

(6) treatment delivered through a neonatal abstinence program operated by pediatric
pain or palliative care subspecialists new text begin ; and
new text end

new text begin (7) any medication approved by the commissioner of health for inclusion in this
subdivision, pursuant to subdivision 6, paragraph (a) new text end .

Clauses (2) to (6) are effective January 1, 2026, and apply to health benefit plans offered,
sold, issued, or renewed on or after that date.

Sec. 2.

Minnesota Statutes 2024, section 62M.07, is amended by adding a subdivision to
read:

new text begin Subd. 6. new text end

new text begin Prior authorization commission. new text end

new text begin (a) The Department of Health must establish
a prior authorization commission to:
new text end

new text begin (1) review the 25 medications with the highest prior authorization denial rates in the
state; and
new text end

new text begin (2) recommend medications for inclusion in the prior authorization prohibition in
subdivision 2, based on the criteria described in paragraph (c).
new text end

new text begin (b) The commission shall consist of nine members, appointed as follows:
new text end

new text begin (1) two representatives of the Department of Health appointed by the commissioner of
health;
new text end

new text begin (2) two representatives of the Department of Commerce appointed by the commissioner
of commerce;
new text end

new text begin (3) two representatives of the Minnesota Prescription Drug Affordability Board appointed
by the governor;
new text end

new text begin (4) one physician appointed by the Minnesota Medical Association;
new text end

new text begin (5) one representative of health plans offering prescription drug benefits appointed by
.......; and
new text end

new text begin (6) one representative of pharmacy benefit managers appointed by ......
new text end

new text begin (c) The commission's recommendations under paragraph (a) must be based on the
following criteria:
new text end

new text begin (1) the medication's cost;
new text end

new text begin (2) the medication's utilization in the general population;
new text end

new text begin (3) the extent to which health plans cover the medication;
new text end

new text begin (4) the medication's effectiveness;
new text end

new text begin (5) the extent to which prohibition of prior authorization may increase premiums for
covered individuals;
new text end

new text begin (6) the medical necessity of the medication for populations of individuals with conditions
treated by the medication; and
new text end

new text begin (7) any other factor the commission determines to be significant in its recommendations
under paragraph (a).
new text end

new text begin (d) By August 1, 2026, and each August 1 thereafter, the commissioner shall submit a
report to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and commerce policy and finance describing:
new text end

new text begin (1) the commission's analysis of the criteria in paragraph (c); and
new text end

new text begin (2) the medications the commission recommends for approval by the commissioner of
health under subdivision 7.
new text end

new text begin (e) Notwithstanding any law to the contrary, government entities are permitted to share
or disseminate data as follows:
new text end

new text begin (1) the commissioner of human services may share data on public program drug benefits
and utilization with the commission; and
new text end

new text begin (2) the commissioner of commerce may share data on private market drug benefits and
utilization with the commission.
new text end

new text begin Data shared under this paragraph may be collected, stored, or used only to make the
recommendations required under this subdivision, and must not be further shared or
disseminated except as otherwise provided by law.
new text end

Sec. 3.

Minnesota Statutes 2024, section 62M.07, is amended by adding a subdivision to
read:

new text begin Subd. 7. new text end

new text begin Commissioner of health approval. new text end

new text begin Pursuant to subdivision 2, clause (7), by
August 1, 2027, and each August 1 thereafter, the commissioner of health must approve
one medication for inclusion in the prior authorization prohibition in subdivision 2. The
medication selected must have been recommended by the prior authorization commission
in the commission's most recently submitted report to the legislature under subdivision 6,
paragraph (d).
new text end