1.1 A bill for an act
1.2 relating to human services; requiring medical assistance coverage of drugs covered
1.3 by a primary third-party payer; requiring coverage of in-network services by
1.4 medical assistance regardless of network or referral status for a primary third-party
1.5 payer; amending Minnesota Statutes 2024, sections 256B.0625, subdivisions 13,
1.6 25b; 256B.37, subdivision 5.
1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.8 Section 1. Minnesota Statutes 2024, section 256B.0625, subdivision 13, is amended to
1.9read:
1.10 Subd. 13.Drugs.(a) Medical assistance covers drugs, except for fertility drugs when
1.11specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
1.12by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
1.13dispensing physician, or by a physician, a physician assistant, or an advanced practice
1.14registered nurse employed by or under contract with a community health board as defined
1.15in section 145A.02, subdivision 5, for the purposes of communicable disease control.
1.16 (b) The dispensed quantity of a prescription drug must not exceed a 34-day supply unless
1.17authorized by the commissioner or as provided in paragraph (h) or the drug appears on the
1.1890-day supply list published by the commissioner. The 90-day supply list shall be published
1.19by the commissioner on the department's website. The commissioner may add to, delete
1.20from, and otherwise modify the 90-day supply list after providing public notice and the
1.21opportunity for a 15-day public comment period. The 90-day supply list may include
1.22cost-effective generic drugs and shall not include controlled substances.
1.23 (c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
1.24ingredient" is defined as a substance that is represented for use in a drug and when used in
1Section 1.
REVISOR AGW/AC 25-0275502/06/25
State of Minnesota
This Document can be made available
in alternative formats upon request
HOUSE OF REPRESENTATIVES
H. F. No. 668
NINETY-FOURTH SESSION
Authored by Hicks and Curran02/13/2025
The bill was read for the first time and referred to the Committee on Health Finance and Policy 2.1the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
2.2drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
2.3for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
2.4excipients which are included in the medical assistance formulary. Medical assistance covers
2.5selected active pharmaceutical ingredients and excipients used in compounded prescriptions
2.6when the compounded combination is specifically approved by the commissioner or when
2.7a commercially available product:
2.8 (1) is not a therapeutic option for the patient;
2.9 (2) does not exist in the same combination of active ingredients in the same strengths
2.10as the compounded prescription; and
2.11 (3) cannot be used in place of the active pharmaceutical ingredient in the compounded
2.12prescription.
2.13 (d) Medical assistance covers the following over-the-counter drugs when prescribed by
2.14a licensed practitioner or by a licensed pharmacist who meets standards established by the
2.15commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
2.16planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
2.17with documented vitamin deficiencies, vitamins for children under the age of seven and
2.18pregnant or nursing women, and any other over-the-counter drug identified by the
2.19commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
2.20and cost-effective for the treatment of certain specified chronic diseases, conditions, or
2.21disorders, and this determination shall not be subject to the requirements of chapter 14. A
2.22pharmacist may prescribe over-the-counter medications as provided under this paragraph
2.23for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
2.24drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
2.25necessity, provide drug counseling, review drug therapy for potential adverse interactions,
2.26and make referrals as needed to other health care professionals.
2.27 (e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
2.28under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
2.29Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
2.30for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
2.31Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
2.32individuals, medical assistance may cover drugs from the drug classes listed in United States
2.33Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
2Section 1.
REVISOR AGW/AC 25-0275502/06/25 3.113g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
3.2not be covered.
3.3 (f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
3.4Program and dispensed by 340B covered entities and ambulatory pharmacies under common
3.5ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
3.6through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.
3.7 (g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
3.8contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
3.9151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
3.10licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
3.11used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
3.12pharmacist in accordance with section 151.37, subdivision 16.
3.13 (h) Medical assistance coverage for a prescription contraceptive must provide a 12-month
3.14supply for any prescription contraceptive if a 12-month supply is prescribed by the
3.15prescribing health care provider. The prescribing health care provider must determine the
3.16appropriate duration for which to prescribe the prescription contraceptives, up to 12 months.
3.17For purposes of this paragraph, "prescription contraceptive" means any drug or device that
3.18requires a prescription and is approved by the Food and Drug Administration to prevent
3.19pregnancy. Prescription contraceptive does not include an emergency contraceptive drug
3.20approved to prevent pregnancy when administered after sexual contact. For purposes of this
3.21paragraph, "health plan" has the meaning provided in section 62Q.01, subdivision 3.
3.22 (i) Notwithstanding subdivisions 13d and 13g, medical assistance covers any drug on
3.23the formulary of the recipient's primary third-party payer for which the primary third-party
3.24payer has made partial payment, regardless of the drug's exclusion from the medical
3.25assistance formulary or preferred drug list. Notwithstanding subdivision 13f, medical
3.26assistance must cover drugs under this paragraph without requiring prior authorization.
3.27Medical assistance must cover drugs under this paragraph regardless of the payment amount
3.28initially covered by the primary third-party payer.
3.29 Sec. 2. Minnesota Statutes 2024, section 256B.0625, subdivision 25b, is amended to read:
3.30 Subd. 25b.Authorization with third-party liability.(a) Except as otherwise allowed
3.31under this subdivision or required under federal or state regulations, the commissioner must
3.32not consider a request for authorization of a service when the recipient has coverage from
3.33a third-party payer unless the provider requesting authorization has made a good faith effort
3Sec. 2.
REVISOR AGW/AC 25-0275502/06/25 4.1to receive payment or authorization from the third-party payer. A good faith effort is
4.2established by supplying with the authorization request to the commissioner the following:
4.3 (1) a determination of payment for the service from the third-party payer, a determination
4.4of authorization for the service from the third-party payer, or a verification of noncoverage
4.5of the service by the third-party payer; and
4.6 (2) the information or records required by the department to document the reason for
4.7the determination or to validate noncoverage from the third-party payer.
4.8 (b) A provider requesting authorization for services covered by Medicare is not required
4.9to bill Medicare before requesting authorization from the commissioner if the provider has
4.10reason to believe that a service covered by Medicare is not eligible for payment. The provider
4.11must document that, because of recent claim experiences with Medicare or because of
4.12written communication from Medicare, coverage is not available for the service.
4.13 (c) Authorization is not required if a third-party payer has made payment that is equal
4.14to or greater than 60 percent of the maximum payment amount for the service allowed under
4.15medical assistance, except that authorization of drugs covered by a primary third-party payer
4.16is not required regardless of payment amount pursuant to subdivision 13, paragraph (i).
4.17 Sec. 3. Minnesota Statutes 2024, section 256B.37, subdivision 5, is amended to read:
4.18 Subd. 5.Private benefits to be used first.(a) Private accident and health care coverage
4.19including Medicare for medical services is primary coverage and must be exhausted before
4.20medical assistance or alternative care services are paid for medical services including home
4.21health care, personal care assistance services, hospice, supplies and equipment, or services
4.22covered under a Centers for Medicare and Medicaid Services waiver. When a person who
4.23is otherwise eligible for medical assistance has private accident or health care coverage,
4.24including Medicare or a prepaid health plan, the private health care benefits available to the
4.25person must be used first and to the fullest extent.
4.26 (b) Medical assistance must cover medical services a primary third-party payer deems
4.27out-of-network or as requiring referral if the medical services are in-network and do not
4.28require a referral under medical assistance.
4Sec. 3.
REVISOR AGW/AC 25-0275502/06/25