HF 4092

as introduced - 91st Legislature (2019 - 2020) Posted on 03/04/2020 03:37pm

A bill for an act
relating to health care; establishing a patient insulin assistance program; requiring
health plan companies to provide notice to enrollees with dependent child coverage
when that coverage ends; appropriating money; amending Minnesota Statutes
2019 Supplement, sections 151.06, subdivision 6; 214.122; proposing coding for
new law in Minnesota Statutes, chapters 62Q; 62V.

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

Section 1.

new text begin [62Q.678] DEPENDENT CHILD NOTICE.
new text end

new text begin Group health plans and health plan companies that offer group or individual health plans
with dependent coverage must provide written notice to an enrollee with dependent-child
coverage that the dependent child's coverage ends when the child reaches the age of 26.
Notice must be sent to the enrollee at the enrollee's last known address at least 90 days
before the dependent child reaches the age of 26. The notice must include the date on which
coverage ends and information on accessing the MNsure website.
new text end

Sec. 2.

new text begin [62V.15] PATIENT INSULIN ASSISTANCE PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin A patient insulin assistance program shall be implemented
by July 1, 2020. The program shall provide access to affordable insulin to eligible individuals,
including access to emergency insulin and access to ongoing insulin supply options.
new text end

new text begin Subd. 2. new text end

new text begin Eligibility requirements. new text end

new text begin (a) To be eligible for the patient insulin assistance
program, an individual must:
new text end

new text begin (1) be a resident of Minnesota with a valid Minnesota identification card that indicates
Minnesota residency including a drivers license, identification card, or permit if the individual
is 18 years of age or older, or if the individual is under the age of 18, the individual's parent
or legal guardian must meet this requirement;
new text end

new text begin (2) have a family income that is equal to or less than 400 percent of the federal poverty
guidelines;
new text end

new text begin (3) not be enrolled in medical assistance or MinnesotaCare;
new text end

new text begin (4) not be eligible to receive health care through the Indian Health Services, TriCare, or
prescription drug benefits through the Department of Veterans Affairs;
new text end

new text begin (5) not have access to prescription drug coverage through an individual or group health
plan that limits the total amount of cost-sharing that an enrollee is required to pay for insulin,
including co-payments, deductibles, or coinsurance to $100 or less for a 30-day supply of
insulin;
new text end

new text begin (6) not be receiving insulin through a manufacturer's patient assistance program; and
new text end

new text begin (7) not have received emergency insulin through this program within the 12 months
preceding the date the application is submitted to MNsure.
new text end

new text begin (b) In addition to meeting the requirements in paragraph (a), an individual who is enrolled
in Medicare may be eligible for emergency insulin if the individual and the individual's
drug plan have incurred prescription drug costs during the calendar year of application in
an amount that meets the coverage gap spending threshold established under Medicare, and
does not have access to insulin for less than $100 for a 30-day supply. An individual who
is enrolled in Medicare is not eligible for the Minnesota assistance program under subdivision
7. Nothing in this paragraph shall be construed to prohibit an individual from applying
directly to an insulin manufacturer's patient assistance program.
new text end

new text begin Subd. 3. new text end

new text begin Application. new text end

new text begin (a) The Board of Directors of MNsure shall develop an application
form to be used for the patient insulin assistance program and make the form accessible to
individuals through MNsure's website. new text end new text begin MNsure may also make the form available to
pharmacies and health care providers who prescribe or dispense insulin, hospital emergency
departments, urgent care clinics, and community health clinics.
new text end

new text begin (b) The application must include the applicant's income, residency status, including the
type of identification card that indicates Minnesota residency, and insurance status
information. The application must also require the applicant to indicate whether insulin is
being requested on an emergency basis and whether the applicant is also applying for the
Minnesota assistance program.
new text end

new text begin (c) An individual may submit a completed and signed application online through the
MNsure website. By signing the application, an individual attests that the information
contained in the application is correct, and consents to MNsure submitting the individual's
information to insulin manufacturers as required under paragraph (d), and to MNsure
processing the individual's application to determine eligibility for the Minnesota assistance
program.
new text end

new text begin (d) Upon receipt of an application, MNsure shall submit an applicant's name and contact
information to each insulin manufacturer for the purpose of informing each manufacturer
that the individual may be eligible for the manufacturer's patient assistance program or
coupon program.
new text end

new text begin (e) Any individual who submits a signed application containing any information that
the individual knows is false or willfully misleading may be subject to section 256.98.
new text end

new text begin Subd. 4. new text end

new text begin MNsure duties; access to emergency insulin and contract. new text end

new text begin (a) Upon receipt
of a completed and signed application, MNsure must provide an applicant requesting insulin
on an emergency basis with: (1) an identification number, indicating that a completed
application has been received; and (2) any information necessary for a pharmacy to dispense
insulin on an emergency basis. This information must be provided in a format that can be
downloaded by the applicant or conveyed in an electronic form.
new text end

new text begin (b) After completing paragraph (a), MNsure must review each application within five
business days of receipt of the application. If an individual attests on the application that
the individual is enrolled in Medicare, MNsure must provide the individual with contact
information for the Senior LinkAge Line and for each insulin manufacturer's patient
assistance program. If the individual does not attest to being enrolled in Medicare, MNsure
must connect the individual with a navigator to assist the individual in determining whether
the individual is eligible to receive insulin on an ongoing basis, in accordance with
subdivision 6.
new text end

new text begin (c) The MNsure Board of Directors may contract with a third-party administrator to
implement this subdivision, and shall contract with a claims adjudicator to process claims
and reimburse pharmacies for insulin provided on an emergency basis under subdivision
5. Payment to the pharmacy must be an amount that at least covers the pharmacy's acquisition
cost for the insulin dispensed. Any payment to the pharmacy is in addition to the co-payment
required to be paid by the individual under subdivision 5, paragraph (d).
new text end

new text begin Subd. 5. new text end

new text begin Pharmacy duties; access to emergency insulin. new text end

new text begin (a) An individual seeking
insulin on an emergency basis must present the identification number, a valid prescription,
and other information specified in subdivision 4 to the pharmacy.
new text end

new text begin (b) Before the insulin is dispensed to the individual, the individual must provide
identification indicating Minnesota residency to the pharmacist in the form of a valid
Minnesota identification card, driver's license, or permit. If the individual needing the
emergency insulin is under the age of 18, the individual accessing the program on behalf
of the minor must be the minor's parent or legal guardian and must provide the pharmacist
with proof of residency as required under this paragraph.
new text end

new text begin (c) Upon receipt of the information required under paragraph (a), and following
compliance with paragraph (b), the pharmacy shall dispense the prescribed insulin in an
amount that is equivalent to a 30-day supply. The pharmacy shall submit the claim in
accordance with the claims processing requirements specified by the claims adjudicator
under contract with the MNsure Board of Directors.
new text end

new text begin (d) An eligible individual is responsible for paying an insulin co-payment to the pharmacy
in an amount of $75 for the 30-day supply of the insulin dispensed by the pharmacy under
this program.
new text end

new text begin Subd. 6. new text end

new text begin Navigator duties. new text end

new text begin (a) Upon receiving the name of an applicant from MNsure,
a navigator shall contact the individual to determine if the individual is eligible for affordable
insulin on an ongoing basis, as provided in this subdivision.
new text end

new text begin (b) The navigator shall first determine if the individual is eligible for medical assistance
or MinnesotaCare. If the navigator determines that the individual is eligible, the navigator
shall assist the individual in applying for the appropriate program.
new text end

new text begin (c) If the navigator determines that the individual is not eligible for medical assistance
or MinnesotaCare, the navigator shall provide the individual with information on, and as
applicable, assist the individual in determining eligibility and applying for the following
sources of ongoing insulin coverage:
new text end

new text begin (1) qualified health plans offered through MNsure, subject to open and special enrollment
periods;
new text end

new text begin (2) providers who are authorized to participate in the 340b program under section 340b
of the federal Public Health Services Act, United States Code, title 42, section 256b;
new text end

new text begin (3) community health centers;
new text end

new text begin (4) insulin manufacturer patient assistance programs; and
new text end

new text begin (5) the Minnesota assistance program established under this section.
new text end

new text begin (d) If the navigator determines that the individual is in need of an additional 30-day
supply of emergency insulin, and the individual is cooperating in enrolling in either medical
assistance or MinnesotaCare or is in the process of accessing the Minnesota assistance
program or another source of ongoing insulin coverage, the navigator shall inform MNsure
and MNsure shall provide the individual with a new identification number to provide to the
pharmacy, indicating the individual is eligible for an additional 30-day supply of insulin.
Following the procedures specified in subdivision 5, the pharmacy shall dispense an
additional 30-day supply of insulin to the individual.
new text end

new text begin Subd. 7. new text end

new text begin MNsure board; Minnesota assistance program. new text end

new text begin (a) Upon completing the
review required under subdivision 4, paragraph (b), MNsure shall continue to process an
individual's application to determine if the individual is eligible for the Minnesota assistance
program, unless the individual is determined to be eligible for medical assistance or
MinnesotaCare.
new text end

new text begin (b) If MNsure determines that the individual is eligible for the Minnesota assistance
program, MNsure shall provide the individual with an eligibility statement indicating that
the individual may participate in the Minnesota assistance program. The eligibility statement
must identify the individual with a unique patient identification number to be submitted by
the health care practitioner when the practitioner submits the order to the manufacturer as
required under subdivision 8. The eligibility statement must also include information
instructing the individual to take the statement to their health care practitioner and must
include each manufacturer's contact information, as provided by the manufacturer, in
accordance with subdivision 9.
new text end

new text begin (c) An individual's eligibility statement is valid until the last day of the next open
enrollment period offered through MNsure after the date the individual receives an eligibility
statement from MNsure. An individual may only access the Minnesota assistance program
one time.
new text end

new text begin Subd. 8. new text end

new text begin Health care practitioner responsibilities; Minnesota assistance program. new text end

new text begin (a)
All health care practitioners must participate in the Minnesota assistance program. For
purposes of this section, "health care practitioner" means a primary care physician or
endocrinologist who is licensed under chapter 147 and is practicing within the state of
Minnesota.
new text end

new text begin (b) Upon receipt of a patient's eligibility statement, the health care practitioner must
submit the patient's eligibility statement, unique identification number, and the name of the
insulin product and the daily dosage amount prescribed by the practitioner to the product's
manufacturer.
new text end

new text begin (c) The health care practitioner must include with the order to the manufacturer the
following information:
new text end

new text begin (1) the health care practitioner's name and shipping address;
new text end

new text begin (2) state license number, expiration date, and national provider identifier (NPI) number;
new text end

new text begin (3) office telephone number, fax number, e-mail address, and an office contact name;
and
new text end

new text begin (4) any specific days or times when deliveries are not accepted by the practitioner.
new text end

new text begin (d) Except as authorized under paragraph (e), the health care practitioner must provide
the insulin to the patient at no charge to the patient, including no charge to the patient for
picking up the insulin at the practitioner's office. The health care practitioner must not
provide insulin received from the manufacturer to any patient other than the patient associated
with the specific order. The health care practitioner must not seek reimbursement for the
insulin received from the manufacturer from any third-party payer.
new text end

new text begin (e) The health care practitioner may charge a patient a co-payment for administration
services not to exceed $25 for each 90-day supply if the insulin is sent to the health care
practitioner.
new text end

new text begin (f) The health care practitioner may submit to a manufacturer a reorder for a patient if
the patient's eligibility statement has not expired.
new text end

new text begin Subd. 9. new text end

new text begin Manufacturer responsibilities; Minnesota assistance program. new text end

new text begin (a) Each
insulin manufacturer licensed under section 151.252 must participate in the Minnesota
assistance program as a condition of doing business in this state. Each insulin manufacturer
must provide MNsure with contact information for the health care practitioner to use when
submitting an order to the manufacturer that includes an e-mail address, fax number,
telephone number, and address. Each insulin manufacturer must also provide MNsure with
contact information for MNsure to send the manufacturer applicant information in accordance
with subdivision 3, paragraph (d).
new text end

new text begin (b) Upon receipt of an order from a health care practitioner and the information described
in subdivision 8, the manufacturer must send to the health care practitioner a 90-day supply
of insulin as ordered, unless a lesser amount is requested in the order, at no charge to the
patient or health care practitioner.
new text end

new text begin (c) Upon receipt of a reorder from a health care practitioner, the manufacturer must send
to the health care practitioner an additional 90-day supply of the product, unless a lesser
amount is requested, at no charge to the patient or health care practitioner if the individual's
eligibility statement has not expired.
new text end

new text begin (d) Notwithstanding paragraph (b) or (c), a manufacturer may send the insulin as ordered
directly to the patient if the manufacturer provides a mail order service option.
new text end

new text begin Subd. 10. new text end

new text begin Data sharing. new text end

new text begin The commissioner of human services and the Board of Directors
of MNsure may enter into an information sharing agreement for purposes of determining
eligibility for the patient insulin assistance program, provided the agreement includes
adequate protections with respect to the confidentiality and integrity of the information to
be shared, and complies with all applicable state and federal laws, regulations, and rules,
including the requirements in section 62V.06.
new text end

new text begin Subd. 11. new text end

new text begin Report. new text end

new text begin (a) By February 15 of each year, beginning February 15, 2021, each
insulin manufacturer must report to the Board of Pharmacy the following:
new text end

new text begin (1) the number of Minnesota residents enrolled in the manufacturer's patient assistance
program in the preceding calendar year;
new text end

new text begin (2) the number of individuals receiving insulin from the manufacturer through the
Minnesota assistance program in the preceding calendar year; and
new text end

new text begin (3) the value of the insulin provided by the manufacturer under clauses (1) and (2).
new text end

new text begin For purposes of this paragraph, "value" means the wholesale acquisition cost of the insulin
provided.
new text end

new text begin (b) By March 15 of each year, beginning March 15, 2021, the Board of Pharmacy shall
submit the information reported in paragraph (a) to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services policy and
finance.
new text end

new text begin (c) By March 15 of each year, beginning March 15, 2021, the Board of Directors of
MNsure shall submit a report to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services policy and finance on the
insulin patient assistance program for the previous calendar year, including:
new text end

new text begin (1) the number of individuals who applied to the program;
new text end

new text begin (2) the number of individuals who accessed emergency insulin through the program;
and
new text end

new text begin (3) the number of individuals who participated in the Minnesota assistance program.
new text end

new text begin Subd. 12. new text end

new text begin Sunset. new text end

new text begin This section expires December 31, 2023, except final reports required
to be submitted under subdivision 11 must be submitted as required by February 15, 2024,
and March 15, 2024.
new text end

Sec. 3.

Minnesota Statutes 2019 Supplement, section 151.06, subdivision 6, is amended
to read:

Subd. 6.

Information provision; sources of lower cost prescription drugs.

(a) The
board shall publish a page on its website that provides regularly updated information
concerning:

(1) patient assistance programs offered by drug manufacturers, including information
on how to access the programs;

(2) new text begin the insulin patient assistance program established in section 62V.15, including a link
to the program's application form and information on how to access the program;
new text end

new text begin (3) new text end the prescription drug assistance program established by the Minnesota Board of
Aging under section 256.975, subdivision 9;

deleted text begin (3) deleted text end new text begin (4) new text end the websites through which individuals can access information concerning
eligibility for and enrollment in Medicare, medical assistance, MinnesotaCare, and other
government-funded programs that help pay for the cost of health care;

deleted text begin (4) deleted text end new text begin (5) new text end availability of providers that are authorized to participate under section 340b of
the federal Public Health Services Act, United States Code, title 42, section 256b;

deleted text begin (5) deleted text end new text begin (6) new text end having a discussion with the pharmacist or the consumer's health care provider
about alternatives to a prescribed drug, including a lower cost or generic drug if the drug
prescribed is too costly for the consumer; and

deleted text begin (6) deleted text end new text begin (7) new text end any other resource that the board deems useful to individuals who are attempting
to purchase prescription drugs at lower costs.

(b) The board must prepare educational materials, including brochures and posters, based
on the information it provides on its website under paragraph (a). The materials must be in
a form that can be downloaded from the board's website and used for patient education by
pharmacists and by health care practitioners who are licensed to prescribe. The board is not
required to provide printed copies of these materials.

(c) The board shall require pharmacists and pharmacies to make available to patients
information on sources of lower cost prescription drugs, including information on the
availability of the website established under paragraph (a).

Sec. 4.

Minnesota Statutes 2019 Supplement, section 214.122, is amended to read:

214.122 INFORMATION PROVISION; PHARMACEUTICAL ASSISTANCE
PROGRAMS.

(a) The Board of Medical Practice and the Board of Nursing shall at least annually inform
licensees who are authorized to prescribe prescription drugs of the availability of the Board
of Pharmacy's website that contains information on resources and programs to assist patients
with the cost of prescription drugs. The boards shall provide licensees with the website
address established by the Board of Pharmacy under section 151.06, subdivision 6, and the
materials described under section 151.06, subdivision 6, paragraph (b). new text begin The boards shall
also ensure that licensees are provided with information on the insulin patient assistance
program established in section 62V.15, and a link to the program's application form and
information on how patients can apply for the program.
new text end

(b) Licensees must make available to patients information on sources of lower cost
prescription drugs, including information on the availability of the website established by
the Board of Pharmacy under section 151.06, subdivision 6.

Sec. 5. new text begin PUBLIC AWARENESS CAMPAIGN.
new text end

new text begin The Board of Directors of MNsure shall conduct a public awareness campaign to create
awareness of the insulin assistance program established under section 62V.15. The campaign
must focus on educating eligible individuals in need of assistance in purchasing insulin of
the existence of the program and on how to apply. The campaign must also focus on
educating health care providers who treat patients with diabetes on the existence of the
program.
new text end

Sec. 6. new text begin APPROPRIATIONS.
new text end

new text begin (a) $250,000 is appropriated in fiscal year 2020 from the health care access fund to the
Board of Directors of MNsure for a public awareness campaign for the insulin patient
assistance program established under Minnesota Statutes, section 62V.15. This is a onetime
appropriation and is available until December 31, 2023.
new text end

new text begin (b) $250,000 is appropriated in fiscal year 2020 from the health care access fund to the
Board of Directors of MNsure to train navigators to provide services as required under
Minnesota Statutes, section 62V.15. This is a onetime appropriation and is available until
December 31, 2023.
new text end

new text begin (c) $....... is appropriated in fiscal year 2020 and $....... is appropriated in fiscal year 2021
from the health care access fund to the Board of Directors of MNsure for the implementation
of the insulin patient assistance program established under Minnesota Statutes, section
62V.15. The base for this appropriation is $....... in fiscal year 2022, $....... in fiscal year
2023, $....... in fiscal year 2024, and $0 in fiscal year 2025.
new text end