1.1 A bill for an act
1.2 relating to health; prohibiting certain formulary changes during the plan year;
1.3 proposing coding for new law in Minnesota Statutes, chapter 62Q.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. [62Q.83] FORMULARY CHANGES.
1.6 Subdivision 1.Definitions.(a) For purposes of this section, the following terms have
1.7the meanings given.
1.8 (b) "Drug" has the meaning given in section 151.01, subdivision 5.
1.9 (c) "Enrollee" has the meaning given in section 62Q.01, subdivision 2b.
1.10 (d) "Formulary" means a current list of covered prescription drug products that is subject
1.11to periodic review and update.
1.12 (e) "Health plan" has the meaning given in section 62Q.01, subdivision 3.
1.13 (f) "Pharmacy benefit manager" has the meaning given in section 62W.02, subdivision
1.1415.
1.15 (g) "Prescription" has the meaning given in section 151.01, subdivision 16a.
1.16 Subd. 2.Formulary changes.(a) Except as provided in paragraphs (b) and (c), a health
1.17plan must not, with respect to an enrollee who was previously prescribed the drug during
1.18the plan year, remove a drug from the health plan's formulary or place a drug in a benefit
1.19category that increases the enrollee's cost for the duration of the enrollee's plan year.
1.20 (b) Paragraph (a) does not apply if a health plan changes the health plan's formulary:
1Section 1.
25-03002 as introduced02/17/25 REVISOR RSI/AC
SENATE
STATE OF MINNESOTA
S.F. No. 1806NINETY-FOURTH SESSION
(SENATE AUTHORS: MANN, Wiklund, Lieske and Gruenhagen)
OFFICIAL STATUSD-PGDATE
Introduction and first reading02/24/2025
Referred to Commerce and Consumer Protection 2.1 (1) for a drug that has been deemed unsafe by the United States Food and Drug
2.2Administration (FDA);
2.3 (2) for a drug that has been withdrawn by the FDA or the drug manufacturer; or
2.4 (3) when an independent source of research, clinical guidelines, or evidence-based
2.5standards has issued drug-specific warnings or recommended changes with respect to a
2.6drug's use for reasons related to previously unknown and imminent patient harm.
2.7 (c) Paragraph (a) does not apply if a health plan removes a brand name drug from the
2.8health plan's formulary or places a brand name drug in a benefit category that increases the
2.9enrollee's cost if the health plan:
2.10 (1) adds to the health plan's formulary a generic or multisource brand name drug rated
2.11as therapeutically equivalent according to the FDA Orange Book, or a biologic drug rated
2.12as interchangeable according to the FDA Purple Book, at a lower cost to the enrollee; and
2.13 (2) provides at least a 60-day notice to prescribers, pharmacists, and affected enrollees.
2.14 EFFECTIVE DATE.This section is effective January 1, 2026, and applies to health
2.15plans offered, sold, issued, or renewed on or after that date.
2Section 1.
25-03002 as introduced02/17/25 REVISOR RSI/AC