Minnesota 2025-2026 Regular Session

Minnesota Senate Bill SF1739 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 health; establishing a prior authorization commission; directing the
3	3	1.3 commissioner of health to approve a medication for prohibition from prior
4	4	1.4 authorization; requiring a report; amending Minnesota Statutes 2024, section
5	5	1.5 62M.07, subdivision 2, by adding subdivisions.
6	6	1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
7	7	1.7 Section 1. Minnesota Statutes 2024, section 62M.07, subdivision 2, is amended to read:
8	8	1.8 Subd. 2.Prior authorization of certain services prohibited.No utilization review
9	9	1.9organization, health plan company, or claims administrator may conduct or require prior
10	10	1.10authorization of:
11	11	1.11 (1) emergency confinement or an emergency service. The enrollee or the enrollee's
12	12	1.12authorized representative may be required to notify the health plan company, claims
13	13	1.13administrator, or utilization review organization as soon as reasonably possible after the
14	14	1.14beginning of the emergency confinement or emergency service;
15	15	1.15 (2) outpatient mental health treatment or outpatient substance use disorder treatment,
16	16	1.16except for treatment which is a medication. Prior authorizations required for medications
17	17	1.17used for outpatient mental health treatment or outpatient substance use disorder treatment
18	18	1.18must be processed according to section 62M.05, subdivision 3b, for initial determinations,
19	19	1.19and according to section 62M.06, subdivision 2, for appeals;
20	20	1.20 (3) antineoplastic cancer treatment that is consistent with guidelines of the National
21	21	1.21Comprehensive Cancer Network, except for treatment which is a medication. Prior
22	22	1.22authorizations required for medications used for antineoplastic cancer treatment must be
23	23	1Section 1.
24	24	25-02331 as introduced02/05/25 REVISOR SGS/ES
25	25	SENATE
26	26	STATE OF MINNESOTA
27	27	S.F. No. 1739NINETY-FOURTH SESSION
28	28	(SENATE AUTHORS: MANN)
29	29	OFFICIAL STATUSD-PGDATE
30	30	Introduction and first reading02/20/2025
31	31	Referred to Health and Human Services 2.1processed according to section 62M.05, subdivision 3b, for initial determinations, and
32	32	2.2according to section 62M.06, subdivision 2, for appeals;
33	33	2.3 (4) services that currently have a rating of A or B from the United States Preventive
34	34	2.4Services Task Force, immunizations recommended by the Advisory Committee on
35	35	2.5Immunization Practices of the Centers for Disease Control and Prevention, or preventive
36	36	2.6services and screenings provided to women as described in Code of Federal Regulations,
37	37	2.7title 45, section 147.130;
38	38	2.8 (5) pediatric hospice services provided by a hospice provider licensed under sections
39	39	2.9144A.75 to 144A.755; and
40	40	2.10 (6) treatment delivered through a neonatal abstinence program operated by pediatric
41	41	2.11pain or palliative care subspecialists; and
42	42	2.12 (7) any medication approved by the commissioner of health for inclusion in this
43	43	2.13subdivision, pursuant to subdivision 6, paragraph (a).
44	44	2.14Clauses (2) to (6) are effective January 1, 2026, and apply to health benefit plans offered,
45	45	2.15sold, issued, or renewed on or after that date.
46	46	2.16 Sec. 2. Minnesota Statutes 2024, section 62M.07, is amended by adding a subdivision to
47	47	2.17read:
48	48	2.18 Subd. 6.Prior authorization commission.(a) The Department of Health must establish
49	49	2.19a prior authorization commission to:
50	50	2.20 (1) review the 25 medications with the highest prior authorization denial rates in the
51	51	2.21state; and
52	52	2.22 (2) recommend medications for inclusion in the prior authorization prohibition in
53	53	2.23subdivision 2, based on the criteria described in paragraph (c).
54	54	2.24 (b) The commission shall consist of nine members, appointed as follows:
55	55	2.25 (1) two representatives of the Department of Health appointed by the commissioner of
56	56	2.26health;
57	57	2.27 (2) two representatives of the Department of Commerce appointed by the commissioner
58	58	2.28of commerce;
59	59	2.29 (3) two representatives of the Minnesota Prescription Drug Affordability Board appointed
60	60	2.30by the governor;
61	61	2.31 (4) one physician appointed by the Minnesota Medical Association;
62	62	2Sec. 2.
63	63	25-02331 as introduced02/05/25 REVISOR SGS/ES 3.1 (5) one representative of health plans offering prescription drug benefits appointed by
64	64	3.2.......; and
65	65	3.3 (6) one representative of pharmacy benefit managers appointed by ......
66	66	3.4 (c) The commission's recommendations under paragraph (a) must be based on the
67	67	3.5following criteria:
68	68	3.6 (1) the medication's cost;
69	69	3.7 (2) the medication's utilization in the general population;
70	70	3.8 (3) the extent to which health plans cover the medication;
71	71	3.9 (4) the medication's effectiveness;
72	72	3.10 (5) the extent to which prohibition of prior authorization may increase premiums for
73	73	3.11covered individuals;
74	74	3.12 (6) the medical necessity of the medication for populations of individuals with conditions
75	75	3.13treated by the medication; and
76	76	3.14 (7) any other factor the commission determines to be significant in its recommendations
77	77	3.15under paragraph (a).
78	78	3.16 (d) By August 1, 2026, and each August 1 thereafter, the commissioner shall submit a
79	79	3.17report to the chairs and ranking minority members of the legislative committees with
80	80	3.18jurisdiction over health and commerce policy and finance describing:
81	81	3.19 (1) the commission's analysis of the criteria in paragraph (c); and
82	82	3.20 (2) the medications the commission recommends for approval by the commissioner of
83	83	3.21health under subdivision 7.
84	84	3.22 (e) Notwithstanding any law to the contrary, government entities are permitted to share
85	85	3.23or disseminate data as follows:
86	86	3.24 (1) the commissioner of human services may share data on public program drug benefits
87	87	3.25and utilization with the commission; and
88	88	3.26 (2) the commissioner of commerce may share data on private market drug benefits and
89	89	3.27utilization with the commission.
90	90	3.28Data shared under this paragraph may be collected, stored, or used only to make the
91	91	3.29recommendations required under this subdivision, and must not be further shared or
92	92	3.30disseminated except as otherwise provided by law.
93	93	3Sec. 2.
94	94	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
95	95	4.2read:
96	96	4.3 Subd. 7.Commissioner of health approval.Pursuant to subdivision 2, clause (7), by
97	97	4.4August 1, 2027, and each August 1 thereafter, the commissioner of health must approve
98	98	4.5one medication for inclusion in the prior authorization prohibition in subdivision 2. The
99	99	4.6medication selected must have been recommended by the prior authorization commission
100	100	4.7in the commission's most recently submitted report to the legislature under subdivision 6,
101	101	4.8paragraph (d).
102	102	4Sec. 3.
103	103	25-02331 as introduced02/05/25 REVISOR SGS/ES