1.1 A bill for an act
1.2 relating to health insurance; requiring coverage of medical services and prescription
1.3 medications for the treatment of dementia; modifying step therapy requirements
1.4 for medical assistance; amending Minnesota Statutes 2024, section 256B.0625,
1.5 subdivision 13f; proposing coding for new law in Minnesota Statutes, chapter 62Q.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. [62Q.546] COVERAGE FOR DEMENTIA.
1.8 (a) A health plan company must provide coverage for every (1) type of medical service,
1.9and (2) prescription medication approved by the United States Food and Drug Administration
1.10that is used to treat or slow the progression of dementia. A health plan company must provide
1.11coverage for diagnostic testing to determine the appropriateness or effectiveness of a medical
1.12service or prescription medication to treat or slow the progression of dementia.
1.13 (b) A health plan company is prohibited from using step therapy protocol, as defined in
1.14section 62Q.184, subdivision 1, when providing the coverage required under paragraph (a).
1.15 EFFECTIVE DATE.This section is effective January 1, 2026, and applies to health
1.16plans offered, issued, or renewed on or after that date.
1.17 Sec. 2. Minnesota Statutes 2024, section 256B.0625, subdivision 13f, is amended to read:
1.18 Subd. 13f.Prior authorization.(a) The Formulary Committee shall review and
1.19recommend drugs which require prior authorization. The Formulary Committee shall
1.20establish general criteria to be used for the prior authorization of brand-name drugs for
1.21which generically equivalent drugs are available, but the committee is not required to review
1.22each brand-name drug for which a generically equivalent drug is available.
1Sec. 2.
25-02558 as introduced02/10/25 REVISOR RSI/HL
SENATE
STATE OF MINNESOTA
S.F. No. 1998NINETY-FOURTH SESSION
(SENATE AUTHORS: BOLDON, Abeler and Kupec)
OFFICIAL STATUSD-PGDATE
Introduction and first reading02/27/2025
Referred to Commerce and Consumer Protection 2.1 (b) Prior authorization may be required by the commissioner before certain formulary
2.2drugs are eligible for payment. The Formulary Committee may recommend drugs for prior
2.3authorization directly to the commissioner. The commissioner may also request that the
2.4Formulary Committee review a drug for prior authorization. Before the commissioner may
2.5require prior authorization for a drug:
2.6 (1) the commissioner must provide information to the Formulary Committee on the
2.7impact that placing the drug on prior authorization may have on the quality of patient care
2.8and on program costs, information regarding whether the drug is subject to clinical abuse
2.9or misuse, and relevant data from the state Medicaid program if such data is available;
2.10 (2) the Formulary Committee must review the drug, taking into account medical and
2.11clinical data and the information provided by the commissioner; and
2.12 (3) the Formulary Committee must hold a public forum and receive public comment for
2.13an additional 15 days.
2.14The commissioner must provide a 15-day notice period before implementing the prior
2.15authorization.
2.16 (c) Except as provided in subdivision 13j, prior authorization shall not be required or
2.17utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness
2.18if:
2.19 (1) there is no generically equivalent drug available; and
2.20 (2) the drug was initially prescribed for the recipient prior to July 1, 2003; or
2.21 (3) the drug is part of the recipient's current course of treatment.
2.22This paragraph applies to any multistate preferred drug list or supplemental drug rebate
2.23program established or administered by the commissioner. Prior authorization shall
2.24automatically be granted for 60 days for brand name drugs prescribed for treatment of mental
2.25illness within 60 days of when a generically equivalent drug becomes available, provided
2.26that the brand name drug was part of the recipient's course of treatment at the time the
2.27generically equivalent drug became available.
2.28 (d) Prior authorization must not be required for liquid methadone if only one version of
2.29liquid methadone is available. If more than one version of liquid methadone is available,
2.30the commissioner shall ensure that at least one version of liquid methadone is available
2.31without prior authorization.
2Sec. 2.
25-02558 as introduced02/10/25 REVISOR RSI/HL 3.1 (e) Prior authorization may be required for an oral liquid form of a drug, except as
3.2described in paragraph (d). A prior authorization request under this paragraph must be
3.3automatically approved within 24 hours if the drug is being prescribed for a Food and Drug
3.4Administration-approved condition for a patient who utilizes an enteral tube for feedings
3.5or medication administration, even if the patient has current or prior claims for pills for that
3.6condition. If more than one version of the oral liquid form of a drug is available, the
3.7commissioner may select the version that is able to be approved for a Food and Drug
3.8Administration-approved condition for a patient who utilizes an enteral tube for feedings
3.9or medication administration. This paragraph applies to any multistate preferred drug list
3.10or supplemental drug rebate program established or administered by the commissioner. The
3.11commissioner shall design and implement a streamlined prior authorization form for patients
3.12who utilize an enteral tube for feedings or medication administration and are prescribed an
3.13oral liquid form of a drug. The commissioner may require prior authorization for brand
3.14name drugs whenever a generically equivalent product is available, even if the prescriber
3.15specifically indicates "dispense as written-brand necessary" on the prescription as required
3.16by section 151.21, subdivision 2.
3.17 (f) Notwithstanding this subdivision, the commissioner may automatically require prior
3.18authorization, for a period not to exceed 180 days, for any drug that is approved by the
3.19United States Food and Drug Administration on or after July 1, 2005. The 180-day period
3.20begins no later than the first day that a drug is available for shipment to pharmacies within
3.21the state. The Formulary Committee shall recommend to the commissioner general criteria
3.22to be used for the prior authorization of the drugs, but the committee is not required to
3.23review each individual drug. In order to continue prior authorizations for a drug after the
3.24180-day period has expired, the commissioner must follow the provisions of this subdivision.
3.25 (g) Prior authorization under this subdivision shall comply with section 62Q.184.
3.26 (h) Any step therapy protocol requirements established by the commissioner must comply
3.27with section sections 62Q.1841 and 62Q.546. The commissioner must apply the step therapy
3.28requirements of sections 62Q.1841 and 62Q.546 to service delivery under fee-for-service.
3.29 (i) Notwithstanding any law to the contrary, prior authorization or step therapy shall not
3.30be required or utilized for any class of drugs that is approved by the United States Food and
3.31Drug Administration for the treatment or prevention of HIV and AIDS.
3.32 EFFECTIVE DATE.This section is effective January 1, 2026.
3Sec. 2.
25-02558 as introduced02/10/25 REVISOR RSI/HL