HF 1485

as introduced - 94th Legislature (2025 - 2026) Posted on 02/24/2025 03:28pm

A bill for an act
relating to health insurance; requiring coverage of over-the-counter contraceptive
drugs, devices, and products by insurers and medical assistance; requiring reports;
amending Minnesota Statutes 2024, sections 62Q.522, subdivisions 1, 2;
256B.0625, subdivision 13.

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

Section 1.

Minnesota Statutes 2024, section 62Q.522, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) The definitions in this subdivision apply to this section.

(b) "Contraceptive method" means a deleted text begin drug, device, or other product approved by the
Food and Drug Administration to prevent unintended pregnancy deleted text end new text begin prescription contraceptive
or over-the-counter contraceptive new text end .

(c) "Contraceptive service new text begin " or "service new text end " means consultation, examination, procedures,
and medical services related to the prevention of unintended pregnancy, excluding
vasectomies. This includes but is not limited to voluntary sterilization procedures, patient
education, counseling on contraceptives, and follow-up services related to contraceptive
methods or services, management of side effects, counseling for continued adherence, and
device insertion or removal.

(d) "Medical necessity" includes but is not limited to considerations such as severity of
side effects, difference in permanence and reversibility of a contraceptive method or service,
and ability to adhere to the appropriate use of the contraceptive method or service, as
determined by the attending provider.

new text begin (e) "Over-the-counter contraceptive" or "OTC contraceptive" means a drug, device, or
other product that:
new text end

new text begin (1) is approved by the Food and Drug Administration to prevent unintended pregnancy;
and
new text end

new text begin (2) does not require a prescription.
new text end

new text begin (f) "Pharmacy" has the meaning given in section 151.01.
new text end

new text begin (g) "Prescription contraceptive" means a drug, device, or other product that:
new text end

new text begin (1) is approved by the Food and Drug Administration to prevent unintended pregnancy;
and
new text end

new text begin (2) requires a prescription.
new text end

deleted text begin (e) deleted text end new text begin (h) new text end "Therapeutic equivalent version" means a drug, device, or product that can be
expected to have the same clinical effect and safety profile when administered to a patient
under the conditions specified in the labeling, and that:

(1) is approved as safe and effective;

(2) is a pharmaceutical equivalent: (i) containing identical amounts of the same active
drug ingredient in the same dosage form and route of administration; and (ii) meeting
compendial or other applicable standards of strength, quality, purity, and identity;

(3) is bioequivalent in that:

(i) the drug, device, or product does not present a known or potential bioequivalence
problem and meets an acceptable in vitro standard; or

(ii) if the drug, device, or product does present a known or potential bioequivalence
problem, it is shown to meet an appropriate bioequivalence standard;

(4) is adequately labeled; and

(5) is manufactured in compliance with current manufacturing practice regulations.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026, and applies to health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2024, section 62Q.522, subdivision 2, is amended to read:

Subd. 2.

Required coverage; cost sharing prohibited.

(a) A health plan must provide
coverage for contraceptive methods and services.

(b) A health plan company must not impose cost-sharing requirements, including co-pays,
deductibles, or coinsurance, for contraceptive methods or services.

(c) A health plan company must not impose any referral requirements, restrictions, or
delays for contraceptive methods or services.

(d) A health plan must include at least one of each type of Food and Drug Administration
approved contraceptive method in its formulary. new text begin Subject to paragraph (g), new text end if more than one
therapeutic equivalent version of a contraceptive method is approved, a health plan must
include at least one therapeutic equivalent version in its formulary, but is not required to
include all therapeutic equivalent versions.

(e) For each health plan, a health plan company must list the contraceptive methods and
services that are covered without cost-sharing in a manner that is easily accessible to
enrollees, health care providers, and representatives of health care providers. The list for
each health plan must be promptly updated to reflect changes to the coverage.

(f) If an enrollee's attending provider recommends a particular contraceptive method or
service based on a determination of medical necessity for that enrollee, the health plan must
cover that contraceptive method or service without cost-sharing. The health plan company
issuing the health plan must defer to the attending provider's determination that the particular
contraceptive method or service is medically necessary for the enrollee.

new text begin (g) Notwithstanding paragraph (d), a health plan must cover all types and brands of OTC
contraceptives purchased at a pharmacy without requiring a prescription.
new text end

new text begin (h) A health plan must cover all OTC contraceptives purchased at a pharmacy at the
point-of-sale without requiring a prescription.
new text end

new text begin (i) A health plan must not limit the type, quantity, or purchase frequency, and must not
impose any restriction or requirement, based on prescription status of OTC contraceptives
purchased at a pharmacy.
new text end

new text begin (j) If the application of this subdivision before an enrollee has met the enrollee's health
plan's deductible results 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 subdivision applies to contraceptive methods and
services only after the enrollee has met the enrollee's health plan's deductible.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026, and applies to health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 3.

Minnesota Statutes 2024, section 256B.0625, subdivision 13, is amended to read:

Subd. 13.

Drugs.

(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, a physician assistant, or an advanced practice
registered nurse employed by or under contract with a community health board as defined
in section 145A.02, subdivision 5, for the purposes of communicable disease control.

(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply unless
authorized by the commissioner or as provided in paragraph (h) or the drug appears on the
90-day supply list published by the commissioner. The 90-day supply list shall be published
by the commissioner on the department's website. The commissioner may add to, delete
from, and otherwise modify the 90-day supply list after providing public notice and the
opportunity for a 15-day public comment period. The 90-day supply list may include
cost-effective generic drugs and shall not include controlled substances.

(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:

(1) is not a therapeutic option for the patient;

(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and

(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.

(d) Medical assistance covers the following over-the-counter drugs new text begin :
new text end

new text begin (1) new text end when prescribed by a licensed practitioner or by a licensed pharmacist who meets
standards established by the commissioner, in consultation with the board of pharmacy:

new text begin (i) new text end antacids deleted text begin , deleted text end new text begin ;
new text end

new text begin (ii) new text end acetaminophen deleted text begin , deleted text end new text begin ;
new text end

new text begin (iii) new text end family planning products deleted text begin , deleted text end new text begin ;
new text end

new text begin (iv) new text end aspirin deleted text begin , deleted text end new text begin ;
new text end

new text begin (v) new text end insulin deleted text begin , deleted text end new text begin ;
new text end

new text begin (vi) new text end products for the treatment of lice deleted text begin , deleted text end new text begin ;
new text end

new text begin (vii) new text end vitamins for adults with documented vitamin deficiencies deleted text begin , deleted text end new text begin ;
new text end

new text begin (viii) new text end vitamins for children under the age of seven and pregnant or nursing women deleted text begin , deleted text end new text begin ; new text end and

new text begin (ix) new text end any other over-the-counter drug identified by the commissioner, in consultation
with the Formulary Committee, as necessary, appropriate, and cost-effective for the treatment
of certain specified chronic diseases, conditions, or disorders deleted text begin , deleted text end new text begin ; new text end and deleted text begin this
deleted text end

new text begin (2) all over-the-counter contraceptives, as defined in section 62Q.522, regardless of
whether the drug has been prescribed.
new text end

new text begin A new text end determination deleted text begin shall deleted text end new text begin by the commissioner under clause (1), item (ix), is new text end not deleted text begin be deleted text end subject to
the requirements of chapter 14. A pharmacist may prescribe over-the-counter medications
as provided under this paragraph for purposes of receiving reimbursement under Medicaid.
When prescribing over-the-counter drugs under this paragraph, licensed pharmacists must
consult with the recipient to determine necessity, provide drug counseling, review drug
therapy for potential adverse interactions, and make referrals as needed to other health care
professionals.

(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.

(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.

(g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
pharmacist in accordance with section 151.37, subdivision 16.

(h) Medical assistance coverage for a prescription contraceptive must provide a 12-month
supply for any prescription contraceptive if a 12-month supply is prescribed by the
prescribing health care provider. The prescribing health care provider must determine the
appropriate duration for which to prescribe the prescription contraceptives, up to 12 months.
For purposes of this paragraph, "prescription contraceptive" means any drug or device that
requires a prescription and is approved by the Food and Drug Administration to prevent
pregnancy. Prescription contraceptive does not include an emergency contraceptive drug
approved to prevent pregnancy when administered after sexual contact. For purposes of this
paragraph, "health plan" has the meaning provided in section 62Q.01, subdivision 3.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026.
new text end

Sec. 4. new text begin OUTREACH AND REPORTS.
new text end

new text begin (a) The Department of Commerce must work with the Departments of Health and Human
Services to provide public information about over-the-counter contraception coverage.
new text end

new text begin (b) The Department of Commerce must work with the Departments of Health and Human
Services and provide a report by March 31, 2027, and annually thereafter, to the standing
committees of the legislature with oversight of issues relating to commerce, health, and
human services. The report must include information and data regarding the use of coverage
and related costs to health plans and the state to provide over-the-counter contraceptives.
new text end