as introduced - 94th Legislature (2025 - 2026) Posted on 04/01/2025 12:34pm
Engrossments | ||
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Introduction | Posted on 02/27/2025 |
A bill for an act
relating to health; prohibiting certain formulary changes during the plan year;
proposing coding for new law in Minnesota Statutes, chapter 62Q.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
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(a) For purposes of this section, the following terms have
the meanings given.
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(b) "Drug" has the meaning given in section 151.01, subdivision 5.
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(c) "Enrollee" has the meaning given in section 62Q.01, subdivision 2b.
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(d) "Formulary" means a current list of covered prescription drug products that is subject
to periodic review and update.
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(e) "Health plan" has the meaning given in section 62Q.01, subdivision 3.
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(f) "Pharmacy benefit manager" has the meaning given in section 62W.02, subdivision
15.
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(g) "Prescription" has the meaning given in section 151.01, subdivision 16a.
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(a) Except as provided in paragraphs (b) and (c), a health
plan must not, with respect to an enrollee who was previously prescribed the drug during
the plan year, remove a drug from the health plan's formulary or place a drug in a benefit
category that increases the enrollee's cost for the duration of the enrollee's plan year.
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(b) Paragraph (a) does not apply if a health plan changes the health plan's formulary:
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(1) for a drug that has been deemed unsafe by the United States Food and Drug
Administration (FDA);
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(2) for a drug that has been withdrawn by the FDA or the drug manufacturer; or
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(3) when an independent source of research, clinical guidelines, or evidence-based
standards has issued drug-specific warnings or recommended changes with respect to a
drug's use for reasons related to previously unknown and imminent patient harm.
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(c) Paragraph (a) does not apply if a health plan removes a brand name drug from the
health plan's formulary or places a brand name drug in a benefit category that increases the
enrollee's cost if the health plan:
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(1) adds to the health plan's formulary a generic or multisource brand name drug rated
as therapeutically equivalent according to the FDA Orange Book, or a biologic drug rated
as interchangeable according to the FDA Purple Book, at a lower cost to the enrollee; and
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(2) provides at least a 60-day notice to prescribers, pharmacists, and affected enrollees.
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This section is effective January 1, 2026, and applies to health
plans offered, sold, issued, or renewed on or after that date.
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