1.1 	A bill for an act
1.2 	relating to human services; limiting the use of prior authorization under medical 
1.3 	assistance program for certain prescription drugs; amending Minnesota Statutes 
1.4 	2005 Supplement, section 256B.0625, subdivision 13f.
1.5 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6 	Section 1. Minnesota Statutes 2005 Supplement, section 256B.0625, subdivision 13f, 
1.7 	is amended to read:
1.8 		Subd. 13f.Prior authorization. (a) The Formulary Committee shall review and 
1.9 	recommend drugs which require prior authorization. The Formulary Committee shall 
1.10 	establish general criteria to be used for the prior authorization of brand-name drugs for 
1.11 	which generically equivalent drugs are available, but the committee is not required to 
1.12 	review each brand-name drug for which a generically equivalent drug is available.
1.13 	(b) Prior authorization may be required by the commissioner before certain 
1.14 	formulary drugs are eligible for payment. The Formulary Committee may recommend 
1.15 	drugs for prior authorization directly to the commissioner. The commissioner may also 
1.16 	request that the Formulary Committee review a drug for prior authorization. Before the 
1.17 	commissioner may require prior authorization for a drug:
1.18 	(1) the commissioner must provide information to the Formulary Committee on the 
1.19 	impact that placing the drug on prior authorization may have on the quality of patient care 
1.20 	and on program costs, information regarding whether the drug is subject to clinical abuse 
1.21 	or misuse, and relevant data from the state Medicaid program if such data is available;
1.22 	(2) the Formulary Committee must review the drug, taking into account medical and 
1.23 	clinical data and the information provided by the commissioner; and
2.1 	(3) the Formulary Committee must hold a public forum and receive public comment 
2.2 	for an additional 15 days.
2.3 	The commissioner must provide a 15-day notice period before implementing the prior 
2.4 	authorization.
2.5 	(c) Prior authorization shall not be required or utilized for any atypical antipsychotic 
2.6 	drug prescribed for the treatment of mental illness if:
2.7 	(1) there is no generically equivalent drug available; and
2.8 	(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or
2.9 	(3) the drug is part of the recipient's current course of treatment.
2.10 	This paragraph applies to any multistate preferred drug list or supplemental drug rebate 
2.11 	program established or administered by the commissioner. Prior authorization shall 
2.12 	automatically be granted for 60 days for brand name drugs prescribed for treatment of 
2.13 	mental illness within 60 days of when a generically equivalent drug becomes available, 
2.14 	provided that the brand name drug was part of the recipient's course of treatment at the 
2.15 	time the generically equivalent drug became available.
2.16 	(d) Prior authorization shall not be required or utilized for any antihemophilic factor 
2.17 	drug prescribed for the treatment of hemophilia and blood disorders where there is no 
2.18 	generically equivalent drug available if the prior authorization is used in conjunction with 
2.19 	any supplemental drug rebate program or multistate preferred drug list established or 
2.20 	administered by the commissioner.
2.21 	(e) Prior authorization shall not be required or utilized for any prescription drug 
2.22 	prescribed for the treatment of cancer, human immunodeficiency virus infection, acquired 
2.23 	immunodeficiency syndrome, or transplantation where there is no generically equivalent 
2.24 	drug available. The commissioner shall provide authorization for a prescribed drug 
2.25 	identified under this paragraph if the following requirements are met: 
2.26 	(1) the prescribing physician is certified as a specialist by a specialty board and 
2.27 	provides documentation of the certification; and 
2.28 	(2) the prescribing physician telephones the department or certifies in writing that: 
2.29 	(i) the prescribed drug is being prescribed consistent with its licensed indication or 
2.30 	with generally accepted medical practices as documented in a standard medical reference; 
2.31 	(ii) the prescribed drug is being used to treat a condition that is normally treated 
2.32 	within the prescribing physician's specialty field; and 
2.33 	(iii) in the physician's professional opinion, no other drug or drugs included on the 
2.34 	preferred drug list can provide a comparable benefit. 
2.35 	An individual who was under a court order for a particular prescription drug 
2.36 	before becoming a medical assistance recipient is exempt from the prior authorization 
3.1 	process and may continue on that medication for the duration of the order. An individual 
3.2 	who is under medical treatment and whose condition has been stabilized under a given 
3.3 	prescription drug regimen before becoming a medical assistance recipient is exempt 
3.4 	from the prior authorization process and may continue on that medication for the current 
3.5 	course of treatment if without that prescription drug regimen the individual would suffer 
3.6 	serious health consequences. 
3.7 	This paragraph does not apply to drugs being provided under a prepaid medical 
3.8 	assistance program contract between the commissioner and a health maintenance 
3.9 	organization. 
3.10 	(f) The commissioner may require prior authorization for brand name drugs 
3.11 	whenever a generically equivalent product is available, even if the prescriber specifically 
3.12 	indicates "dispense as written-brand necessary" on the prescription as required by section 
3.13 	151.21, subdivision 2.
3.14 	~~(f)~~ (g) Notwithstanding this subdivision, the commissioner may automatically 
3.15 	require prior authorization, for a period not to exceed 180 days, for any drug that is 
3.16 	approved by the United States Food and Drug Administration on or after July 1, 2005. 
3.17 	The 180-day period begins no later than the first day that a drug is available for shipment 
3.18 	to pharmacies within the state. The Formulary Committee shall recommend to the 
3.19 	commissioner general criteria to be used for the prior authorization of the drugs, but 
3.20 	the committee is not required to review each individual drug. In order to continue prior 
3.21 	authorizations for a drug after the 180-day period has expired, the commissioner must 
3.22 	follow the provisions of this subdivision.