HF 1652

as introduced - 94th Legislature (2025 - 2026) Posted on 04/01/2025 12:34pm

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:

Section 1.

new text begin [62Q.83] FORMULARY CHANGES.
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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 terms have
the meanings given.
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new text begin (b) "Drug" has the meaning given in section 151.01, subdivision 5.
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new text begin (c) "Enrollee" has the meaning given in section 62Q.01, subdivision 2b.
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new text begin (d) "Formulary" means a current list of covered prescription drug products that is subject
to periodic review and update.
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new text begin (e) "Health plan" has the meaning given in section 62Q.01, subdivision 3.
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new text begin (f) "Pharmacy benefit manager" has the meaning given in section 62W.02, subdivision
15.
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new text begin (g) "Prescription" has the meaning given in section 151.01, subdivision 16a.
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new text begin Subd. 2. new text end

new text begin Formulary changes. new text end

new text begin (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.
new text end

new text begin (b) Paragraph (a) does not apply if a health plan changes the health plan's formulary:
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new text begin (1) for a drug that has been deemed unsafe by the United States Food and Drug
Administration (FDA);
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new text begin (2) for a drug that has been withdrawn by the FDA or the drug manufacturer; or
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new text begin (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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new text begin (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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new text begin (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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new text begin (2) provides at least a 60-day notice to prescribers, pharmacists, and affected enrollees.
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new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end