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