HF 2009

2nd Engrossment - 91st Legislature (2019 - 2020) Posted on 07/09/2019 01:58pm

A bill for an act
relating to health; prohibiting health plan companies and the commissioner of
human services from requiring enrollees to follow step therapy protocols for certain
metastatic cancers; amending Minnesota Statutes 2018, section 256B.0625,
subdivision 13f; 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.1841] PROHIBITION ON USE OF STEP THERAPY FOR
METASTATIC CANCER.
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 following definitions
apply.
new text end

new text begin (b) "Health plan" has the meaning given in section 62Q.01, subdivision 3. Health plan
includes health coverage provided by a county-based purchasing plan participating in a
public program under chapter 256B or 256L or an integrated health partnership under section
256B.0755.
new text end

new text begin (c) "Stage four advanced metastatic cancer" means cancer that has spread from the
primary or original site of the cancer to nearby tissues, lymph nodes, or other parts of the
body.
new text end

new text begin (d) "Step therapy protocol" has the meaning given in section 62Q.184, subdivision 1.
new text end

new text begin Subd. 2. new text end

new text begin Prohibition on use of step therapy protocols. new text end

new text begin A health plan that provides
coverage for the treatment of stage four advanced metastatic cancer or associated conditions
must not limit or exclude coverage for a drug approved by the United States Food and Drug
Administration that is on the health plan's prescription drug formulary by mandating that
an enrollee with stage four advanced metastatic cancer or associated conditions follow a
step therapy protocol if the use of the approved drug is consistent with:
new text end

new text begin (1) a United States Food and Drug Administration-approved indication; and
new text end

new text begin (2) a clinical practice guideline published by the National Comprehensive Care Network.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020, and applies to health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2018, section 256B.0625, subdivision 13f, is amended to read:

Subd. 13f.

Prior authorization.

(a) The Formulary Committee shall review and
recommend drugs which require prior authorization. The Formulary Committee shall
establish general criteria to be used for the prior authorization of brand-name drugs for
which generically equivalent drugs are available, but the committee is not required to review
each brand-name drug for which a generically equivalent drug is available.

(b) Prior authorization may be required by the commissioner before certain formulary
drugs are eligible for payment. The Formulary Committee may recommend drugs for prior
authorization directly to the commissioner. The commissioner may also request that the
Formulary Committee review a drug for prior authorization. Before the commissioner may
require prior authorization for a drug:

(1) the commissioner must provide information to the Formulary Committee on the
impact that placing the drug on prior authorization may have on the quality of patient care
and on program costs, information regarding whether the drug is subject to clinical abuse
or misuse, and relevant data from the state Medicaid program if such data is available;

(2) the Formulary Committee must review the drug, taking into account medical and
clinical data and the information provided by the commissioner; and

(3) the Formulary Committee must hold a public forum and receive public comment for
an additional 15 days.

The commissioner must provide a 15-day notice period before implementing the prior
authorization.

(c) Except as provided in subdivision 13j, prior authorization shall not be required or
utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness
if:

(1) there is no generically equivalent drug available; and

(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or

(3) the drug is part of the recipient's current course of treatment.

This paragraph applies to any multistate preferred drug list or supplemental drug rebate
program established or administered by the commissioner. Prior authorization shall
automatically be granted for 60 days for brand name drugs prescribed for treatment of mental
illness within 60 days of when a generically equivalent drug becomes available, provided
that the brand name drug was part of the recipient's course of treatment at the time the
generically equivalent drug became available.

(d) Prior authorization shall not be required or utilized for any antihemophilic factor
drug prescribed for the treatment of hemophilia and blood disorders where there is no
generically equivalent drug available if the prior authorization is used in conjunction with
any supplemental drug rebate program or multistate preferred drug list established or
administered by the commissioner.

(e) The commissioner may require prior authorization for brand name drugs whenever
a generically equivalent product is available, even if the prescriber specifically indicates
"dispense as written-brand necessary" on the prescription as required by section 151.21,
subdivision 2.

(f) Notwithstanding this subdivision, the commissioner may automatically require prior
authorization, for a period not to exceed 180 days, for any drug that is approved by the
United States Food and Drug Administration on or after July 1, 2005. The 180-day period
begins no later than the first day that a drug is available for shipment to pharmacies within
the state. The Formulary Committee shall recommend to the commissioner general criteria
to be used for the prior authorization of the drugs, but the committee is not required to
review each individual drug. In order to continue prior authorizations for a drug after the
180-day period has expired, the commissioner must follow the provisions of this subdivision.

new text begin (g) Any step therapy protocol requirements established by the commissioner must comply
with section 62Q.1841.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2020.
new text end