HF 2606

as introduced - 89th Legislature (2015 - 2016) Posted on 03/15/2016 09:20am

A bill for an act
relating to insurance; health; requiring coverage for 12 months of contraceptives;
amending Minnesota Statutes 2015 Supplement, section 256B.0625, subdivision
13; 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.521] COVERAGE FOR CONTRACEPTIVES.
new text end

new text begin Subdivision 1. new text end

new text begin Scope of coverage. new text end

new text begin All health plans that provide prescription
contraceptive coverage must comply with the requirements of this section.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, "prescription contraceptive"
means any drug or device that requires a prescription and is approved by the United States
Food and Drug Administration to prevent pregnancy.
new text end

new text begin Subd. 3. new text end

new text begin Required coverage. new text end

new text begin Health plan coverage for a prescription contraceptive
must provide:
new text end

new text begin (1) a three-month supply for the first dispensing of a covered prescription
contraceptive; and
new text end

new text begin (2) a 12-month supply for any subsequent dispensing of the same prescription
contraceptive, regardless of whether the insured was covered by the health plan at the
time of the first dispensing.
new text end

Sec. 2.

Minnesota Statutes 2015 Supplement, 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, physician assistant, or a nurse
practitioner 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 new text begin and except as provided in paragraph (g) new text end .

(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 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: antacids, acetaminophen,
family planning products, aspirin, insulin, products for the treatment of lice, vitamins for
adults with documented vitamin deficiencies, vitamins for children under the age of seven
and pregnant or nursing women, and 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, and this determination shall not be 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. Over-the-counter medications must be dispensed in a quantity that is
the lowest of: (1) the number of dosage units contained in the manufacturer's original
package; (2) the number of dosage units required to complete the patient's course of
therapy; or (3) if applicable, the number of dosage units dispensed from a system using
retrospective billing, as provided under subdivision 13e, paragraph (b).

(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.

new text begin (g) Medical assistance coverage for a prescription contraceptive must provide:
new text end

new text begin (1) a three-month supply for the first dispensing of a covered prescription
contraceptive; and
new text end

new text begin (2) a 12-month supply for any subsequent dispensing of the same prescription
contraceptive, regardless of whether the insured was covered by medical assistance or the
health plan at the time of the first dispensing.
new text end

new text begin For purposes of this paragraph, "prescription contraceptive" means any drug or device that
requires a prescription and is approved by the United States Food and Drug Administration
to prevent pregnancy. For purposes of this paragraph, "health plan" has the meaning
provided in section 62Q.01, subdivision 3.
new text end

Sec. 3. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 and 2 apply to health plan coverage offered, issued, or renewed on or
after January 1, 2017. Sections 1 and 2 apply to medical assistance and MinnesotaCare
coverage effective January 1, 2017.
new text end