HF 795

as introduced - 90th Legislature (2017 - 2018) Posted on 03/29/2017 11:31am

A bill for an act
relating to health; requiring health plans and public health care programs to cover
a 12-month supply of prescription contraceptives; providing religious exemptions;
requiring health plans to cover contraceptive methods, sterilization, and related
medical services, patient education, and counseling; amending Minnesota Statutes
2016, 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 OF CONTRACEPTIVE METHODS AND
COUNSELING.
new text end

new text begin Subdivision 1. new text end

new text begin Citation. new text end

new text begin This section may be cited as the "Contraceptive Health Equity
and Employee Rights Act."
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) The definitions in this subdivision apply to this section.
new text end

new text begin (b) "Contraceptive services" means consultation, examination, procedures, and medical
services related to the use of contraceptive methods, including natural family planning, to
prevent an unintended pregnancy.
new text end

new text begin (c) "Medical necessity" includes but is not limited to considerations such as severity of
side effects, differences in permanence and reversibility of a contraceptive, and ability to
adhere to the appropriate use of the item or service, as determined by the attending provider.
new text end

new text begin (d) "Therapeutic equivalent version" means drugs, devices, or products that can be
expected to have the same clinical effect and safety profile when administered to patients
under the conditions specified in the labeling and that:
new text end

new text begin (1) are approved as safe and effective;
new text end

new text begin (2) are pharmaceutical equivalents in that they contain identical amounts of the same
active drug ingredient in the same dosage form and route of administration, and they meet
compendial or other applicable standards of strength, quality, purity, and identity;
new text end

new text begin (3) are bioequivalent in that (i) they do not present a known or potential bioequivalence
problem and meet an acceptable in vitro standard; or (ii) if they do present a known or
potential bioequivalence problem, they are shown to meet an appropriate bioequivalence
standard;
new text end

new text begin (4) are adequately labeled; and
new text end

new text begin (5) are manufactured in compliance with current good manufacturing practice regulations.
new text end

new text begin Subd. 3. new text end

new text begin Scope of coverage. new text end

new text begin This section applies to all health plans.
new text end

new text begin Subd. 4. new text end

new text begin Required coverage; cost sharing prohibited. new text end

new text begin (a) A health plan that provides
prescription drug coverage must cover:
new text end

new text begin (1) all contraceptive drugs, devices, and other products approved by the Food and Drug
Administration, including all over-the-counter contraceptive drugs, devices, and products
approved by the Food and Drug Administration, but excluding male condoms;
new text end

new text begin (2) voluntary sterilization procedures;
new text end

new text begin (3) contraceptive services, patient education, and counseling on contraception; and
new text end

new text begin (4) follow-up services related to the drugs, devices, products, and procedures covered
under this subdivision, including but not limited to management of side effects, counseling
for continued adherence, and device insertion and removal.
new text end

new text begin (b) For coverage required by this subdivision, a health plan must not impose cost-sharing
requirements, restrictions, or delays.
new text end

new text begin (c) If the Food and Drug Administration has approved one or more therapeutic equivalent
versions of a contraceptive drug, device, or product, a health plan is not required to include
all therapeutic equivalent versions in its formulary, so long as at least one version is included
and covered without cost sharing according to this subdivision.
new text end

new text begin (d) If an individual's attending provider recommends a particular service or item approved
by the Food and Drug Administration based on a determination of medical necessity for
that individual, the health plan must cover that service or item without cost sharing. The
health plan company issuing the health plan must defer to the determination of the individual's
attending physician that the service or item is medically necessary for the individual.
new text end

new text begin (e) If a contraceptive drug, device, or product is not covered by a health plan, the health
plan company must have an easily accessible, transparent, and expedient process that is not
unduly burdensome to the individual, a representative of the individual, or a provider, to
ensure coverage without cost sharing.
new text end

new text begin Subd. 5. new text end

new text begin Exempted coverage. new text end

new text begin (a) A health plan company that has issued or renewed a
health plan to a Minnesota employer to cover employees and their dependents shall provide
a basis for eligible employers to be exempted from the required coverage under subdivision
4. For purposes of this section, an eligible employer includes:
new text end

new text begin (1) any organization that would qualify under Code of Federal Regulations, title 45,
section 147.13, paragraph (b); or
new text end

new text begin (2) any employer organized as a closely held, for-profit corporation that:
new text end

new text begin (i) provides a health plan to cover employees and their dependents;
new text end

new text begin (ii) has employment policies that are derived from principal shareholder beliefs; and
new text end

new text begin (iii) limits or proposes to limit the availability of specific employee benefits due to those
beliefs.
new text end

new text begin (b) An eligible employer and a health plan company shall follow the contraceptive
coverage procedures adopted under Code of Federal Regulations, title 45, section 147.131,
including, but not limited to, the eligible employer issuing a self-certification described in
Code of Federal Regulations, title 45, section 147.131, paragraph (b)(4), and the health plan
company providing coverage required under subdivision 4 to employees or dependents of
an eligible employer at no additional charge to the employee or eligible employer, as
described in Code of Federal Regulations, title 45, section 147.131, paragraph (c).
new text end

new text begin Subd. 6. new text end

new text begin Expiration. new text end

new text begin This section expires if any federal law, rule, opinion, or guidance
is enacted, adopted, or issued that would require the state to defray the cost of coverage
required by subdivision 4. The commissioner of commerce shall notify the revisor of statutes
if this section expires. The state shall not assume any obligation for the cost of coverage
specified in subdivision 4, paragraph (a).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2018, and applies to coverage
offered, sold, issued, or renewed on or after that date.
new text end

Sec. 2.

new text begin [62Q.522] COVERAGE FOR PRESCRIPTION CONTRACEPTIVES;
SUPPLY REQUIREMENTS.
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 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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2018, and applies to coverage
offered, sold, issued, or renewed on or after that date.
new text end

Sec. 3.

Minnesota Statutes 2016, 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 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

new text begin EFFECTIVE DATE. new text end

new text begin This section applies to medical assistance and MinnesotaCare
coverage effective January 1, 2018.
new text end