HF 3217

as introduced - 86th Legislature (2009 - 2010) Posted on 03/01/2010 08:59am

A bill for an act
relating to insurance; limiting excessive enrollee cost-sharing on biologic
prescription drugs; 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.528] BIOLOGIC PRESCRIPTION DRUGS; LIMITATION ON
ENROLLEE COST-SHARING.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the terms defined in
this subdivision have the meanings given.
new text end

new text begin (b) "Biologic product" means a virus, therapeutic serum, toxin, antitoxin, vaccine,
blood, blood component or derivative, allergenic product, protein-based peptide-based
product, or analogous product, or arsphenamine or derivative of arsphenamine, or any
other trivalent organic arsenic compound, applicable to the prevention, treatment, or cure
of a disease or condition of human beings.
new text end

new text begin (c) "Enrollee" has the meaning given in section 62Q.01, subdivision 2a.
new text end

new text begin (d) "FDA" means the federal Food and Drug Administration.
new text end

new text begin (e) "Health plan" has the meaning given in section 62Q.01, subdivision 3, but also
includes the coverage described in section 62A.011, subdivision 3, clauses (7) and (10).
new text end

new text begin Subd. 2. new text end

new text begin Enrollee cost-sharing limited. new text end

new text begin (a) An enrollee prescribed an
FDA-approved biologic product and whose gross income is at or below 400 percent of the
federal poverty guidelines must not be charged a co-payment, coinsurance, deductible, or
other special payment requirement at a rate that exceeds the co-payment, coinsurance,
deductible, or other special payment requirement assessed the lowest-cost nonformulary
brand-name FDA-approved medication in the enrollee's health plan's prescription
medication formulary.
new text end

new text begin (b) An enrollee prescribed an FDA-approved biologic product and whose gross
income is above 400 percent of the federal poverty guidelines must not be charged a
co-payment, coinsurance, deductible, or other special payment requirement at a rate that
exceeds an amount double the co-payment, coinsurance, deductible, or other special
payment requirement assessed the lowest-cost nonformulary brand-name FDA-approved
medication in the enrollee's health plan's prescription medication formulary.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2010, and applies to
coverage issued or renewed before, on, or after that date.
new text end