Minnesota 2025-2026 Regular Session

Minnesota House Bill HF668 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 human services; requiring medical assistance coverage of drugs covered
3	3	1.3 by a primary third-party payer; requiring coverage of in-network services by
4	4	1.4 medical assistance regardless of network or referral status for a primary third-party
5	5	1.5 payer; amending Minnesota Statutes 2024, sections 256B.0625, subdivisions 13,
6	6	1.6 25b; 256B.37, subdivision 5.
7	7	1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
8	8	1.8 Section 1. Minnesota Statutes 2024, section 256B.0625, subdivision 13, is amended to
9	9	1.9read:
10	10	1.10 Subd. 13.Drugs.(a) Medical assistance covers drugs, except for fertility drugs when
11	11	1.11specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
12	12	1.12by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
13	13	1.13dispensing physician, or by a physician, a physician assistant, or an advanced practice
14	14	1.14registered nurse employed by or under contract with a community health board as defined
15	15	1.15in section 145A.02, subdivision 5, for the purposes of communicable disease control.
16	16	1.16 (b) The dispensed quantity of a prescription drug must not exceed a 34-day supply unless
17	17	1.17authorized by the commissioner or as provided in paragraph (h) or the drug appears on the
18	18	1.1890-day supply list published by the commissioner. The 90-day supply list shall be published
19	19	1.19by the commissioner on the department's website. The commissioner may add to, delete
20	20	1.20from, and otherwise modify the 90-day supply list after providing public notice and the
21	21	1.21opportunity for a 15-day public comment period. The 90-day supply list may include
22	22	1.22cost-effective generic drugs and shall not include controlled substances.
23	23	1.23 (c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
24	24	1.24ingredient" is defined as a substance that is represented for use in a drug and when used in
25	25	1Section 1.
26	26	REVISOR AGW/AC 25-0275502/06/25
27	27	State of Minnesota
28	28	This Document can be made available
29	29	in alternative formats upon request
30	30	HOUSE OF REPRESENTATIVES
31	31	H. F. No. 668
32	32	NINETY-FOURTH SESSION
33	33	Authored by Hicks and Curran02/13/2025
34	34	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
35	35	2.2drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
36	36	2.3for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
37	37	2.4excipients which are included in the medical assistance formulary. Medical assistance covers
38	38	2.5selected active pharmaceutical ingredients and excipients used in compounded prescriptions
39	39	2.6when the compounded combination is specifically approved by the commissioner or when
40	40	2.7a commercially available product:
41	41	2.8 (1) is not a therapeutic option for the patient;
42	42	2.9 (2) does not exist in the same combination of active ingredients in the same strengths
43	43	2.10as the compounded prescription; and
44	44	2.11 (3) cannot be used in place of the active pharmaceutical ingredient in the compounded
45	45	2.12prescription.
46	46	2.13 (d) Medical assistance covers the following over-the-counter drugs when prescribed by
47	47	2.14a licensed practitioner or by a licensed pharmacist who meets standards established by the
48	48	2.15commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
49	49	2.16planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
50	50	2.17with documented vitamin deficiencies, vitamins for children under the age of seven and
51	51	2.18pregnant or nursing women, and any other over-the-counter drug identified by the
52	52	2.19commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
53	53	2.20and cost-effective for the treatment of certain specified chronic diseases, conditions, or
54	54	2.21disorders, and this determination shall not be subject to the requirements of chapter 14. A
55	55	2.22pharmacist may prescribe over-the-counter medications as provided under this paragraph
56	56	2.23for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
57	57	2.24drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
58	58	2.25necessity, provide drug counseling, review drug therapy for potential adverse interactions,
59	59	2.26and make referrals as needed to other health care professionals.
60	60	2.27 (e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
61	61	2.28under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
62	62	2.29Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
63	63	2.30for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
64	64	2.31Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
65	65	2.32individuals, medical assistance may cover drugs from the drug classes listed in United States
66	66	2.33Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
67	67	2Section 1.
68	68	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
69	69	3.2not be covered.
70	70	3.3 (f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
71	71	3.4Program and dispensed by 340B covered entities and ambulatory pharmacies under common
72	72	3.5ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
73	73	3.6through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.
74	74	3.7 (g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
75	75	3.8contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
76	76	3.9151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
77	77	3.10licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
78	78	3.11used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
79	79	3.12pharmacist in accordance with section 151.37, subdivision 16.
80	80	3.13 (h) Medical assistance coverage for a prescription contraceptive must provide a 12-month
81	81	3.14supply for any prescription contraceptive if a 12-month supply is prescribed by the
82	82	3.15prescribing health care provider. The prescribing health care provider must determine the
83	83	3.16appropriate duration for which to prescribe the prescription contraceptives, up to 12 months.
84	84	3.17For purposes of this paragraph, "prescription contraceptive" means any drug or device that
85	85	3.18requires a prescription and is approved by the Food and Drug Administration to prevent
86	86	3.19pregnancy. Prescription contraceptive does not include an emergency contraceptive drug
87	87	3.20approved to prevent pregnancy when administered after sexual contact. For purposes of this
88	88	3.21paragraph, "health plan" has the meaning provided in section 62Q.01, subdivision 3.
89	89	3.22 (i) Notwithstanding subdivisions 13d and 13g, medical assistance covers any drug on
90	90	3.23the formulary of the recipient's primary third-party payer for which the primary third-party
91	91	3.24payer has made partial payment, regardless of the drug's exclusion from the medical
92	92	3.25assistance formulary or preferred drug list. Notwithstanding subdivision 13f, medical
93	93	3.26assistance must cover drugs under this paragraph without requiring prior authorization.
94	94	3.27Medical assistance must cover drugs under this paragraph regardless of the payment amount
95	95	3.28initially covered by the primary third-party payer.
96	96	3.29 Sec. 2. Minnesota Statutes 2024, section 256B.0625, subdivision 25b, is amended to read:
97	97	3.30 Subd. 25b.Authorization with third-party liability.(a) Except as otherwise allowed
98	98	3.31under this subdivision or required under federal or state regulations, the commissioner must
99	99	3.32not consider a request for authorization of a service when the recipient has coverage from
100	100	3.33a third-party payer unless the provider requesting authorization has made a good faith effort
101	101	3Sec. 2.
102	102	REVISOR AGW/AC 25-0275502/06/25 4.1to receive payment or authorization from the third-party payer. A good faith effort is
103	103	4.2established by supplying with the authorization request to the commissioner the following:
104	104	4.3 (1) a determination of payment for the service from the third-party payer, a determination
105	105	4.4of authorization for the service from the third-party payer, or a verification of noncoverage
106	106	4.5of the service by the third-party payer; and
107	107	4.6 (2) the information or records required by the department to document the reason for
108	108	4.7the determination or to validate noncoverage from the third-party payer.
109	109	4.8 (b) A provider requesting authorization for services covered by Medicare is not required
110	110	4.9to bill Medicare before requesting authorization from the commissioner if the provider has
111	111	4.10reason to believe that a service covered by Medicare is not eligible for payment. The provider
112	112	4.11must document that, because of recent claim experiences with Medicare or because of
113	113	4.12written communication from Medicare, coverage is not available for the service.
114	114	4.13 (c) Authorization is not required if a third-party payer has made payment that is equal
115	115	4.14to or greater than 60 percent of the maximum payment amount for the service allowed under
116	116	4.15medical assistance, except that authorization of drugs covered by a primary third-party payer
117	117	4.16is not required regardless of payment amount pursuant to subdivision 13, paragraph (i).
118	118	4.17 Sec. 3. Minnesota Statutes 2024, section 256B.37, subdivision 5, is amended to read:
119	119	4.18 Subd. 5.Private benefits to be used first.(a) Private accident and health care coverage
120	120	4.19including Medicare for medical services is primary coverage and must be exhausted before
121	121	4.20medical assistance or alternative care services are paid for medical services including home
122	122	4.21health care, personal care assistance services, hospice, supplies and equipment, or services
123	123	4.22covered under a Centers for Medicare and Medicaid Services waiver. When a person who
124	124	4.23is otherwise eligible for medical assistance has private accident or health care coverage,
125	125	4.24including Medicare or a prepaid health plan, the private health care benefits available to the
126	126	4.25person must be used first and to the fullest extent.
127	127	4.26 (b) Medical assistance must cover medical services a primary third-party payer deems
128	128	4.27out-of-network or as requiring referral if the medical services are in-network and do not
129	129	4.28require a referral under medical assistance.
130	130	4Sec. 3.
131	131	REVISOR AGW/AC 25-0275502/06/25