Minnesota 2025-2026 Regular Session

Minnesota House Bill HF1485 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1.1 A bill for an act
2	2	1.2 relating to health insurance; requiring coverage of over-the-counter contraceptive
3	3	1.3 drugs, devices, and products by insurers and medical assistance; requiring reports;
4	4	1.4 amending Minnesota Statutes 2024, sections 62Q.522, subdivisions 1, 2;
5	5	1.5 256B.0625, subdivision 13.
6	6	1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
7	7	1.7 Section 1. Minnesota Statutes 2024, section 62Q.522, subdivision 1, is amended to read:
8	8	1.8 Subdivision 1.Definitions.(a) The definitions in this subdivision apply to this section.
9	9	1.9 (b) "Contraceptive method" means a drug, device, or other product approved by the
10	10	1.10Food and Drug Administration to prevent unintended pregnancy prescription contraceptive
11	11	1.11or over-the-counter contraceptive.
12	12	1.12 (c) "Contraceptive service" or "service" means consultation, examination, procedures,
13	13	1.13and medical services related to the prevention of unintended pregnancy, excluding
14	14	1.14vasectomies. This includes but is not limited to voluntary sterilization procedures, patient
15	15	1.15education, counseling on contraceptives, and follow-up services related to contraceptive
16	16	1.16methods or services, management of side effects, counseling for continued adherence, and
17	17	1.17device insertion or removal.
18	18	1.18 (d) "Medical necessity" includes but is not limited to considerations such as severity of
19	19	1.19side effects, difference in permanence and reversibility of a contraceptive method or service,
20	20	1.20and ability to adhere to the appropriate use of the contraceptive method or service, as
21	21	1.21determined by the attending provider.
22	22	1.22 (e) "Over-the-counter contraceptive" or "OTC contraceptive" means a drug, device, or
23	23	1.23other product that:
24	24	1Section 1.
25	25	REVISOR RSI/HL 25-0242501/29/25
26	26	State of Minnesota
27	27	This Document can be made available
28	28	in alternative formats upon request
29	29	HOUSE OF REPRESENTATIVES
30	30	H. F. No. 1485
31	31	NINETY-FOURTH SESSION 2.1 (1) is approved by the Food and Drug Administration to prevent unintended pregnancy;
32	32	2.2and
33	33	2.3 (2) does not require a prescription.
34	34	2.4 (f) "Pharmacy" has the meaning given in section 151.01.
35	35	2.5 (g) "Prescription contraceptive" means a drug, device, or other product that:
36	36	2.6 (1) is approved by the Food and Drug Administration to prevent unintended pregnancy;
37	37	2.7and
38	38	2.8 (2) requires a prescription.
39	39	2.9 (e) (h) "Therapeutic equivalent version" means a drug, device, or product that can be
40	40	2.10expected to have the same clinical effect and safety profile when administered to a patient
41	41	2.11under the conditions specified in the labeling, and that:
42	42	2.12 (1) is approved as safe and effective;
43	43	2.13 (2) is a pharmaceutical equivalent: (i) containing identical amounts of the same active
44	44	2.14drug ingredient in the same dosage form and route of administration; and (ii) meeting
45	45	2.15compendial or other applicable standards of strength, quality, purity, and identity;
46	46	2.16 (3) is bioequivalent in that:
47	47	2.17 (i) the drug, device, or product does not present a known or potential bioequivalence
48	48	2.18problem and meets an acceptable in vitro standard; or
49	49	2.19 (ii) if the drug, device, or product does present a known or potential bioequivalence
50	50	2.20problem, it is shown to meet an appropriate bioequivalence standard;
51	51	2.21 (4) is adequately labeled; and
52	52	2.22 (5) is manufactured in compliance with current manufacturing practice regulations.
53	53	2.23 EFFECTIVE DATE.This section is effective January 1, 2026, and applies to health
54	54	2.24plans offered, issued, or renewed on or after that date.
55	55	2.25 Sec. 2. Minnesota Statutes 2024, section 62Q.522, subdivision 2, is amended to read:
56	56	2.26 Subd. 2.Required coverage; cost sharing prohibited.(a) A health plan must provide
57	57	2.27coverage for contraceptive methods and services.
58	58	2.28 (b) A health plan company must not impose cost-sharing requirements, including co-pays,
59	59	2.29deductibles, or coinsurance, for contraceptive methods or services.
60	60	2Sec. 2.
61	61	REVISOR RSI/HL 25-0242501/29/25 3.1 (c) A health plan company must not impose any referral requirements, restrictions, or
62	62	3.2delays for contraceptive methods or services.
63	63	3.3 (d) A health plan must include at least one of each type of Food and Drug Administration
64	64	3.4approved contraceptive method in its formulary. Subject to paragraph (g), if more than one
65	65	3.5therapeutic equivalent version of a contraceptive method is approved, a health plan must
66	66	3.6include at least one therapeutic equivalent version in its formulary, but is not required to
67	67	3.7include all therapeutic equivalent versions.
68	68	3.8 (e) For each health plan, a health plan company must list the contraceptive methods and
69	69	3.9services that are covered without cost-sharing in a manner that is easily accessible to
70	70	3.10enrollees, health care providers, and representatives of health care providers. The list for
71	71	3.11each health plan must be promptly updated to reflect changes to the coverage.
72	72	3.12 (f) If an enrollee's attending provider recommends a particular contraceptive method or
73	73	3.13service based on a determination of medical necessity for that enrollee, the health plan must
74	74	3.14cover that contraceptive method or service without cost-sharing. The health plan company
75	75	3.15issuing the health plan must defer to the attending provider's determination that the particular
76	76	3.16contraceptive method or service is medically necessary for the enrollee.
77	77	3.17 (g) Notwithstanding paragraph (d), a health plan must cover all types and brands of OTC
78	78	3.18contraceptives purchased at a pharmacy without requiring a prescription.
79	79	3.19 (h) A health plan must cover all OTC contraceptives purchased at a pharmacy at the
80	80	3.20point-of-sale without requiring a prescription.
81	81	3.21 (i) A health plan must not limit the type, quantity, or purchase frequency, and must not
82	82	3.22impose any restriction or requirement, based on prescription status of OTC contraceptives
83	83	3.23purchased at a pharmacy.
84	84	3.24 (j) If the application of this subdivision before an enrollee has met the enrollee's health
85	85	3.25plan's deductible results in: (1) health savings account ineligibility under United States
86	86	3.26Code, title 26, section 223; or (2) catastrophic health plan ineligibility under United States
87	87	3.27Code, title 42, section 18022(e), then this subdivision applies to contraceptive methods and
88	88	3.28services only after the enrollee has met the enrollee's health plan's deductible.
89	89	3.29 EFFECTIVE DATE.This section is effective January 1, 2026, and applies to health
90	90	3.30plans offered, issued, or renewed on or after that date.
91	91	3Sec. 2.
92	92	REVISOR RSI/HL 25-0242501/29/25 4.1 Sec. 3. Minnesota Statutes 2024, section 256B.0625, subdivision 13, is amended to read:
93	93	4.2 Subd. 13.Drugs.(a) Medical assistance covers drugs, except for fertility drugs when
94	94	4.3specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
95	95	4.4by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
96	96	4.5dispensing physician, or by a physician, a physician assistant, or an advanced practice
97	97	4.6registered nurse employed by or under contract with a community health board as defined
98	98	4.7in section 145A.02, subdivision 5, for the purposes of communicable disease control.
99	99	4.8 (b) The dispensed quantity of a prescription drug must not exceed a 34-day supply unless
100	100	4.9authorized by the commissioner or as provided in paragraph (h) or the drug appears on the
101	101	4.1090-day supply list published by the commissioner. The 90-day supply list shall be published
102	102	4.11by the commissioner on the department's website. The commissioner may add to, delete
103	103	4.12from, and otherwise modify the 90-day supply list after providing public notice and the
104	104	4.13opportunity for a 15-day public comment period. The 90-day supply list may include
105	105	4.14cost-effective generic drugs and shall not include controlled substances.
106	106	4.15 (c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
107	107	4.16ingredient" is defined as a substance that is represented for use in a drug and when used in
108	108	4.17the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
109	109	4.18drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
110	110	4.19for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
111	111	4.20excipients which are included in the medical assistance formulary. Medical assistance covers
112	112	4.21selected active pharmaceutical ingredients and excipients used in compounded prescriptions
113	113	4.22when the compounded combination is specifically approved by the commissioner or when
114	114	4.23a commercially available product:
115	115	4.24 (1) is not a therapeutic option for the patient;
116	116	4.25 (2) does not exist in the same combination of active ingredients in the same strengths
117	117	4.26as the compounded prescription; and
118	118	4.27 (3) cannot be used in place of the active pharmaceutical ingredient in the compounded
119	119	4.28prescription.
120	120	4.29 (d) Medical assistance covers the following over-the-counter drugs:
121	121	4.30 (1) when prescribed by a licensed practitioner or by a licensed pharmacist who meets
122	122	4.31standards established by the commissioner, in consultation with the board of pharmacy:
123	123	4.32 (i) antacids,;
124	124	4.33 (ii) acetaminophen,;
125	125	4Sec. 3.
126	126	REVISOR RSI/HL 25-0242501/29/25 5.1 (iii) family planning products,;
127	127	5.2 (iv) aspirin,;
128	128	5.3 (v) insulin,;
129	129	5.4 (vi) products for the treatment of lice,;
130	130	5.5 (vii) vitamins for adults with documented vitamin deficiencies,;
131	131	5.6 (viii) vitamins for children under the age of seven and pregnant or nursing women,; and
132	132	5.7 (ix) any other over-the-counter drug identified by the commissioner, in consultation
133	133	5.8with the Formulary Committee, as necessary, appropriate, and cost-effective for the treatment
134	134	5.9of certain specified chronic diseases, conditions, or disorders,; and this
135	135	5.10 (2) all over-the-counter contraceptives, as defined in section 62Q.522, regardless of
136	136	5.11whether the drug has been prescribed.
137	137	5.12A determination shall by the commissioner under clause (1), item (ix), is not be subject to
138	138	5.13the requirements of chapter 14. A pharmacist may prescribe over-the-counter medications
139	139	5.14as provided under this paragraph for purposes of receiving reimbursement under Medicaid.
140	140	5.15When prescribing over-the-counter drugs under this paragraph, licensed pharmacists must
141	141	5.16consult with the recipient to determine necessity, provide drug counseling, review drug
142	142	5.17therapy for potential adverse interactions, and make referrals as needed to other health care
143	143	5.18professionals.
144	144	5.19 (e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
145	145	5.20under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
146	146	5.21Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
147	147	5.22for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
148	148	5.23Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
149	149	5.24individuals, medical assistance may cover drugs from the drug classes listed in United States
150	150	5.25Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
151	151	5.2613g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
152	152	5.27not be covered.
153	153	5.28 (f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
154	154	5.29Program and dispensed by 340B covered entities and ambulatory pharmacies under common
155	155	5.30ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
156	156	5.31through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.
157	157	5Sec. 3.
158	158	REVISOR RSI/HL 25-0242501/29/25 6.1 (g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
159	159	6.2contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
160	160	6.3151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
161	161	6.4licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
162	162	6.5used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
163	163	6.6pharmacist in accordance with section 151.37, subdivision 16.
164	164	6.7 (h) Medical assistance coverage for a prescription contraceptive must provide a 12-month
165	165	6.8supply for any prescription contraceptive if a 12-month supply is prescribed by the
166	166	6.9prescribing health care provider. The prescribing health care provider must determine the
167	167	6.10appropriate duration for which to prescribe the prescription contraceptives, up to 12 months.
168	168	6.11For purposes of this paragraph, "prescription contraceptive" means any drug or device that
169	169	6.12requires a prescription and is approved by the Food and Drug Administration to prevent
170	170	6.13pregnancy. Prescription contraceptive does not include an emergency contraceptive drug
171	171	6.14approved to prevent pregnancy when administered after sexual contact. For purposes of this
172	172	6.15paragraph, "health plan" has the meaning provided in section 62Q.01, subdivision 3.
173	173	6.16 EFFECTIVE DATE.This section is effective January 1, 2026.
174	174	6.17 Sec. 4. OUTREACH AND REPORTS.
175	175	6.18 (a) The Department of Commerce must work with the Departments of Health and Human
176	176	6.19Services to provide public information about over-the-counter contraception coverage.
177	177	6.20 (b) The Department of Commerce must work with the Departments of Health and Human
178	178	6.21Services and provide a report by March 31, 2027, and annually thereafter, to the standing
179	179	6.22committees of the legislature with oversight of issues relating to commerce, health, and
180	180	6.23human services. The report must include information and data regarding the use of coverage
181	181	6.24and related costs to health plans and the state to provide over-the-counter contraceptives.
182	182	6Sec. 4.
183	183	REVISOR RSI/HL 25-0242501/29/25