1.1 A bill for an act
1.2 relating to health care; modifying utilization review for prescription drug coverage;
1.3 amending Minnesota Statutes 2024, sections 62M.02, subdivision 12; 62M.17,
1.4 subdivision 2, by adding a subdivision.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2024, section 62M.02, subdivision 12, is amended to read:
1.7 Subd. 12.Health benefit plan.(a) "Health benefit plan" means:
1.8 (1) a policy, contract, or certificate issued by a health plan company for the coverage of
1.9medical, dental, prescription drug, or hospital benefits; or
1.10 (2) effective January 1, 2026, for the sections specified in section 62M.01, subdivision
1.113, paragraph (c), coverage of medical, dental, or hospital benefits through fee-for-service
1.12under chapters 256B and 256L, as specified by the commissioner on the agency's public
1.13website or through other forms of recipient and provider guidance.
1.14 (b) A health benefit plan does not include coverage that is:
1.15 (1) limited to disability or income protection coverage;
1.16 (2) automobile medical payment coverage;
1.17 (3) supplemental to liability insurance;
1.18 (4) designed solely to provide payments on a per diem, fixed indemnity, or nonexpense
1.19incurred basis;
1.20 (5) credit accident and health insurance issued under chapter 62B;
1.21 (6) blanket accident and sickness insurance as defined in section 62A.11;
1Section 1.
25-02811 as introduced02/10/25 REVISOR SGS/MI
SENATE
STATE OF MINNESOTA
S.F. No. 1340NINETY-FOURTH SESSION
(SENATE AUTHORS: PHA)
OFFICIAL STATUSD-PGDATE
Introduction and first reading02/13/2025
Referred to Commerce and Consumer Protection 2.1 (7) accident only coverage issued by a licensed and tested insurance agent; or
2.2 (8) workers' compensation.
2.3 Sec. 2. Minnesota Statutes 2024, section 62M.17, subdivision 2, is amended to read:
2.4 Subd. 2.Effect of change in prior authorization clinical criteria.(a) If, during a plan
2.5year, a utilization review organization changes coverage terms for a health care service or
2.6the clinical criteria used to conduct prior authorizations for a health care service, the change
2.7in coverage terms or change in clinical criteria shall not apply until the next plan year for
2.8any enrollee who received prior authorization for a health care service using the coverage
2.9terms or clinical criteria in effect before the effective date of the change.
2.10 (b) Paragraph (a) does not apply if a utilization review organization changes coverage
2.11terms for a drug or device that has been deemed unsafe by the United States Food and Drug
2.12Administration (FDA); that has been withdrawn by either the FDA or the product
2.13manufacturer; or when an independent source of research, clinical guidelines, or
2.14evidence-based standards has issued drug- or device-specific warnings or recommended
2.15changes in drug or device usage.
2.16 (c) Paragraph (a) does not apply if a utilization review organization changes coverage
2.17terms for a service or the clinical criteria used to conduct prior authorizations for a service
2.18when an independent source of research, clinical guidelines, or evidence-based standards
2.19has recommended changes in usage of the service for reasons related to patient harm. This
2.20paragraph expires December 31, 2025, for health benefit plans offered, sold, issued, or
2.21renewed on or after that date.
2.22 (d) Effective January 1, 2026, and applicable to health benefit plans offered, sold, issued,
2.23or renewed on or after that date, paragraph (a) does not apply if a utilization review
2.24organization changes coverage terms for a service or the clinical criteria used to conduct
2.25prior authorizations for a service when an independent source of research, clinical guidelines,
2.26or evidence-based standards has recommended changes in usage of the service for reasons
2.27related to previously unknown and imminent patient harm.
2.28 (e) Paragraph (a) does not apply if a utilization review organization removes a brand
2.29name drug from its formulary or places a brand name drug in a benefit category that increases
2.30the enrollee's cost, provided the utilization review organization (1) adds to its formulary a
2.31generic or multisource brand name drug rated as therapeutically equivalent according to
2.32the FDA Orange Book, or a biologic drug rated as interchangeable according to the FDA
2Sec. 2.
25-02811 as introduced02/10/25 REVISOR SGS/MI 3.1Purple Book, at a lower cost to the enrollee, and (2) provides at least a 60-day notice to
3.2prescribers, pharmacists, and affected enrollees.
3.3 Sec. 3. Minnesota Statutes 2024, section 62M.17, is amended by adding a subdivision to
3.4read:
3.5 Subd. 3.Prescription drug authorization.(a) Any authorization for a prescription drug
3.6must remain valid for the duration of an enrollee's contract term, provided the drug continues
3.7to be prescribed for a patient with a condition that requires ongoing medication therapy.
3.8 (b) Paragraph (a) does not apply if a utilization review organization invalidates an
3.9authorization for a prescription drug that has been deemed unsafe by the United States Food
3.10and Drug Administration (FDA) or that has been withdrawn by either the FDA or the drug
3.11manufacturer, or when an independent source of research, clinical guidelines, or
3.12evidence-based standards have issued drug-specific warnings or recommended changes in
3.13drug usage.
3Sec. 3.
25-02811 as introduced02/10/25 REVISOR SGS/MI