1.1 A bill for an act
1.2 relating to health; establishing a prior authorization commission; directing the
1.3 commissioner of health to approve a medication for prohibition from prior
1.4 authorization; requiring a report; amending Minnesota Statutes 2024, section
1.5 62M.07, subdivision 2, by adding subdivisions.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. Minnesota Statutes 2024, section 62M.07, subdivision 2, is amended to read:
1.8 Subd. 2.Prior authorization of certain services prohibited.No utilization review
1.9organization, health plan company, or claims administrator may conduct or require prior
1.10authorization of:
1.11 (1) emergency confinement or an emergency service. The enrollee or the enrollee's
1.12authorized representative may be required to notify the health plan company, claims
1.13administrator, or utilization review organization as soon as reasonably possible after the
1.14beginning of the emergency confinement or emergency service;
1.15 (2) outpatient mental health treatment or outpatient substance use disorder treatment,
1.16except for treatment which is a medication. Prior authorizations required for medications
1.17used for outpatient mental health treatment or outpatient substance use disorder treatment
1.18must be processed according to section 62M.05, subdivision 3b, for initial determinations,
1.19and according to section 62M.06, subdivision 2, for appeals;
1.20 (3) antineoplastic cancer treatment that is consistent with guidelines of the National
1.21Comprehensive Cancer Network, except for treatment which is a medication. Prior
1.22authorizations required for medications used for antineoplastic cancer treatment must be
1Section 1.
25-02331 as introduced02/05/25 REVISOR SGS/ES
SENATE
STATE OF MINNESOTA
S.F. No. 1739NINETY-FOURTH SESSION
(SENATE AUTHORS: MANN)
OFFICIAL STATUSD-PGDATE
Introduction and first reading02/20/2025
Referred to Health and Human Services 2.1processed according to section 62M.05, subdivision 3b, for initial determinations, and
2.2according to section 62M.06, subdivision 2, for appeals;
2.3 (4) services that currently have a rating of A or B from the United States Preventive
2.4Services Task Force, immunizations recommended by the Advisory Committee on
2.5Immunization Practices of the Centers for Disease Control and Prevention, or preventive
2.6services and screenings provided to women as described in Code of Federal Regulations,
2.7title 45, section 147.130;
2.8 (5) pediatric hospice services provided by a hospice provider licensed under sections
2.9144A.75 to 144A.755; and
2.10 (6) treatment delivered through a neonatal abstinence program operated by pediatric
2.11pain or palliative care subspecialists; and
2.12 (7) any medication approved by the commissioner of health for inclusion in this
2.13subdivision, pursuant to subdivision 6, paragraph (a).
2.14Clauses (2) to (6) are effective January 1, 2026, and apply to health benefit plans offered,
2.15sold, issued, or renewed on or after that date.
2.16 Sec. 2. Minnesota Statutes 2024, section 62M.07, is amended by adding a subdivision to
2.17read:
2.18 Subd. 6.Prior authorization commission.(a) The Department of Health must establish
2.19a prior authorization commission to:
2.20 (1) review the 25 medications with the highest prior authorization denial rates in the
2.21state; and
2.22 (2) recommend medications for inclusion in the prior authorization prohibition in
2.23subdivision 2, based on the criteria described in paragraph (c).
2.24 (b) The commission shall consist of nine members, appointed as follows:
2.25 (1) two representatives of the Department of Health appointed by the commissioner of
2.26health;
2.27 (2) two representatives of the Department of Commerce appointed by the commissioner
2.28of commerce;
2.29 (3) two representatives of the Minnesota Prescription Drug Affordability Board appointed
2.30by the governor;
2.31 (4) one physician appointed by the Minnesota Medical Association;
2Sec. 2.
25-02331 as introduced02/05/25 REVISOR SGS/ES 3.1 (5) one representative of health plans offering prescription drug benefits appointed by
3.2.......; and
3.3 (6) one representative of pharmacy benefit managers appointed by ......
3.4 (c) The commission's recommendations under paragraph (a) must be based on the
3.5following criteria:
3.6 (1) the medication's cost;
3.7 (2) the medication's utilization in the general population;
3.8 (3) the extent to which health plans cover the medication;
3.9 (4) the medication's effectiveness;
3.10 (5) the extent to which prohibition of prior authorization may increase premiums for
3.11covered individuals;
3.12 (6) the medical necessity of the medication for populations of individuals with conditions
3.13treated by the medication; and
3.14 (7) any other factor the commission determines to be significant in its recommendations
3.15under paragraph (a).
3.16 (d) By August 1, 2026, and each August 1 thereafter, the commissioner shall submit a
3.17report to the chairs and ranking minority members of the legislative committees with
3.18jurisdiction over health and commerce policy and finance describing:
3.19 (1) the commission's analysis of the criteria in paragraph (c); and
3.20 (2) the medications the commission recommends for approval by the commissioner of
3.21health under subdivision 7.
3.22 (e) Notwithstanding any law to the contrary, government entities are permitted to share
3.23or disseminate data as follows:
3.24 (1) the commissioner of human services may share data on public program drug benefits
3.25and utilization with the commission; and
3.26 (2) the commissioner of commerce may share data on private market drug benefits and
3.27utilization with the commission.
3.28Data shared under this paragraph may be collected, stored, or used only to make the
3.29recommendations required under this subdivision, and must not be further shared or
3.30disseminated except as otherwise provided by law.
3Sec. 2.
25-02331 as introduced02/05/25 REVISOR SGS/ES 4.1 Sec. 3. Minnesota Statutes 2024, section 62M.07, is amended by adding a subdivision to
4.2read:
4.3 Subd. 7.Commissioner of health approval.Pursuant to subdivision 2, clause (7), by
4.4August 1, 2027, and each August 1 thereafter, the commissioner of health must approve
4.5one medication for inclusion in the prior authorization prohibition in subdivision 2. The
4.6medication selected must have been recommended by the prior authorization commission
4.7in the commission's most recently submitted report to the legislature under subdivision 6,
4.8paragraph (d).
4Sec. 3.
25-02331 as introduced02/05/25 REVISOR SGS/ES