1.1 A bill for an act
1.2 relating to human services; expanding prior authorization mental health carve out;
1.3 amending Minnesota Statutes 2024, section 256B.0625, subdivision 13f.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2024, section 256B.0625, subdivision 13f, is amended to
1.6read:
1.7 Subd. 13f.Prior authorization.(a) The Formulary Committee shall review and
1.8recommend drugs which require prior authorization. The Formulary Committee shall
1.9establish general criteria to be used for the prior authorization of brand-name drugs for
1.10which generically equivalent drugs are available, but the committee is not required to review
1.11each brand-name drug for which a generically equivalent drug is available.
1.12 (b) Prior authorization may be required by the commissioner before certain formulary
1.13drugs are eligible for payment. The Formulary Committee may recommend drugs for prior
1.14authorization directly to the commissioner. The commissioner may also request that the
1.15Formulary Committee review a drug for prior authorization. Before the commissioner may
1.16require prior authorization for a drug:
1.17 (1) the commissioner must provide information to the Formulary Committee on the
1.18impact that placing the drug on prior authorization may have on the quality of patient care
1.19and on program costs, information regarding whether the drug is subject to clinical abuse
1.20or misuse, and relevant data from the state Medicaid program if such data is available;
1.21 (2) the Formulary Committee must review the drug, taking into account medical and
1.22clinical data and the information provided by the commissioner; and
1Section 1.
REVISOR AGW/DD 25-0442503/05/25
State of Minnesota
This Document can be made available
in alternative formats upon request
HOUSE OF REPRESENTATIVES
H. F. No. 2533
NINETY-FOURTH SESSION
Authored by Schomacker and Bahner03/20/2025
The bill was read for the first time and referred to the Committee on Human Services Finance and Policy 2.1 (3) the Formulary Committee must hold a public forum and receive public comment for
2.2an additional 15 days.
2.3The commissioner must provide a 15-day notice period before implementing the prior
2.4authorization.
2.5 (c) Except as provided in subdivision 13j, prior authorization or other utilization
2.6management controls shall not be required or utilized for any atypical antipsychotic drug a
2.7central nervous system prescription drug classified as an anticonvulsant, antidepressant,
2.8antipsychotic, or noncontrolled substance antianxiety drug prescribed for the treatment of
2.9mental illness if:.
2.10 (1) there is no generically equivalent drug available; and
2.11 (2) the drug was initially prescribed for the recipient prior to July 1, 2003; or
2.12 (3) the drug is part of the recipient's current course of treatment.
2.13 This (d) Paragraph (c) applies to any multistate preferred drug list or supplemental drug
2.14rebate program established or administered by the commissioner. Prior authorization shall
2.15automatically be granted for 60 days for brand name drugs prescribed for treatment of mental
2.16illness within 60 days of when a generically equivalent drug becomes available, provided
2.17that the brand name drug was part of the recipient's course of treatment at the time the
2.18generically equivalent drug became available.
2.19 (e) For purposes of paragraph (c), "utilization management controls" means a set of
2.20formal techniques used by a health carrier or prescription drug utilization management entity
2.21that is designed to monitor the use of prescription drugs or evaluate the drugs' medical
2.22necessity, appropriateness, efficacy, and efficiency, including but not limited to prior
2.23authorization processes and step therapy protocols as defined in section 62Q.1841.
2.24 (d) (f) Prior authorization must not be required for liquid methadone if only one version
2.25of liquid methadone is available. If more than one version of liquid methadone is available,
2.26the commissioner shall ensure that at least one version of liquid methadone is available
2.27without prior authorization.
2.28 (e) (g) Prior authorization may be required for an oral liquid form of a drug, except as
2.29described in paragraph (d) (f). A prior authorization request under this paragraph must be
2.30automatically approved within 24 hours if the drug is being prescribed for a Food and Drug
2.31Administration-approved condition for a patient who utilizes an enteral tube for feedings
2.32or medication administration, even if the patient has current or prior claims for pills for that
2.33condition. If more than one version of the oral liquid form of a drug is available, the
2Section 1.
REVISOR AGW/DD 25-0442503/05/25 3.1commissioner may select the version that is able to be approved for a Food and Drug
3.2Administration-approved condition for a patient who utilizes an enteral tube for feedings
3.3or medication administration. This paragraph applies to any multistate preferred drug list
3.4or supplemental drug rebate program established or administered by the commissioner. The
3.5commissioner shall design and implement a streamlined prior authorization form for patients
3.6who utilize an enteral tube for feedings or medication administration and are prescribed an
3.7oral liquid form of a drug. The commissioner may require prior authorization for brand
3.8name drugs whenever a generically equivalent product is available, even if the prescriber
3.9specifically indicates "dispense as written-brand necessary" on the prescription as required
3.10by section 151.21, subdivision 2.
3.11 (f) (h) Notwithstanding this subdivision, the commissioner may automatically require
3.12prior authorization, for a period not to exceed 180 days, for any drug that is approved by
3.13the United States Food and Drug Administration on or after July 1, 2005. The 180-day
3.14period begins no later than the first day that a drug is available for shipment to pharmacies
3.15within the state. The Formulary Committee shall recommend to the commissioner general
3.16criteria to be used for the prior authorization of the drugs, but the committee is not required
3.17to review each individual drug. In order to continue prior authorizations for a drug after the
3.18180-day period has expired, the commissioner must follow the provisions of this subdivision.
3.19 (g) (i) Prior authorization under this subdivision shall comply with section 62Q.184.
3.20 (h) (j) Any step therapy protocol requirements established by the commissioner must
3.21comply with section 62Q.1841.
3.22 (i) (k) Notwithstanding any law to the contrary, prior authorization or step therapy shall
3.23not be required or utilized for any class of drugs that is approved by the United States Food
3.24and Drug Administration for the treatment or prevention of HIV and AIDS.
3Section 1.
REVISOR AGW/DD 25-0442503/05/25