HF 633

2nd Engrossment - 92nd Legislature (2021 - 2022) Posted on 03/30/2022 12:54pm

A bill for an act
relating to insurance; requiring individual and small group health plan offerings
to include a predeductible, flat co-pay on prescription drug option; amending
Minnesota Statutes 2020, section 62Q.81, by adding a subdivision.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2020, section 62Q.81, is amended by adding a subdivision
to read:

Subd. 6.

Prescription drug benefits.

(a) A health plan company that offers individual
health plans must ensure that no fewer than 25 percent of the individual health plans the
company offers in each geographic area that the health plan company services at each level
of coverage described in subdivision 1, paragraph (b), clause (3), that the health plan offers,
applies a predeductible, flat-dollar amount co-payment structure to the entire drug benefit,
including all tiers.

(b) A health plan company that offers small group health plans must ensure that no fewer
than 25 percent of small group health plans the company offers in each geographic area that
the health plan company services at each level of coverage described in subdivision 1,
paragraph (b), clause (3), that the health plan offers, applies a predeductible, flat-dollar
amount co-payment structure to the entire drug benefit, including all tiers.

(c) The highest allowable co-payment for the highest cost drug tier for health plans
offered pursuant to this subdivision must be no greater than 1/12 of the plan's out-of-pocket
maximum for an individual.

(d) The flat-dollar amount co-payment tier structure for prescription drugs under this
subdivision must be graduated and proportionate.

(e) All individual and small group health plans offered pursuant to this subdivision must
be:

(1) clearly and appropriately named to aid the purchaser in the selection process;

(2) marketed in the same manner as other health plans offered by the health plan company;
and

(3) offered for purchase to any individual or small group.

(f) This subdivision does not apply to catastrophic plans, grandfathered plans, large
group health plans, health savings accounts (HSAs), qualified high deductible health benefit
plans, limited health benefit plans, or short-term limited-duration health insurance policies.

(g) Neither a health plan company nor a pharmacy benefit manager, as defined in section
62W.02, subdivision 15, shall delay or divide payment to a pharmacy or pharmacy provider,
as defined in section 62W.02, subdivision 14, because of the co-payment structure of a
health plan offered pursuant to this subdivision.

(h) Health plan companies must meet the requirements in this subdivision separately for
plans offered through MNsure under chapter 62V and plans offered outside of MNsure.

EFFECTIVE DATE.

This section is effective January 1, 2024, and applies to individual
and small group health plans offered, issued, or renewed on or after that date.