Minnesota House Bill HF1076

Minnesota 2025-2026 Regular Session

• Introduced: 2/17/25
• Refer: 2/17/25

Caption

Pharmacy benefit managers and health carriers required to include lower-cost drugs in their formularies, and formulary structure and formulary tiering for each health plan required to give preference to the drug with the lowest out-of-pocket cost to the patient.

Impact

Should HF1076 be enacted, it will significantly alter the landscape of drug formularies within health plans across the state. The bill requires that formularies not only include the lowest-cost drugs but also prohibits imposing barriers such as prior authorization or step therapy for these preferred medications. This change is expected to enhance patient access to affordable medications, which could lead to overall better health outcomes and potentially reduce healthcare expenditures for individuals who rely on prescription drugs.

Summary

HF1076 is a legislative proposal in Minnesota aimed at enhancing healthcare affordability by mandating that pharmacy benefit managers (PBMs) and health carriers include lower-cost medications within their formularies. This bill specifically targets the pricing structures of drugs by requiring such entities to give preference to medications with the lowest out-of-pocket costs for patients. It applies to various categories of drugs, including brand-name drugs, generic drugs, and biologics, ensuring that if a higher-cost drug is included in a formulary, its lower-cost alternatives must also be listed and accessible.

Contention

Despite its potential benefits, the bill may face opposition from various stakeholders within the pharmaceutical industry and healthcare providers. Concerns may arise over the operational impacts on PBMs and health carriers, who may argue that mandated changes to formulary structures could undermine their ability to negotiate prices and manage healthcare costs effectively. Additionally, there may be debates regarding the implications of prioritizing drug costs over other factors such as quality and clinical outcomes, which could lead to a contentious discussion among legislators and healthcare advocates.