The bill amends Minnesota Statutes 2024, specifically section 256B.0625, to clarify medical assistance coverage for prescription drugs in instances where individuals have cost-effective health insurance. It introduces provisions that require medical assistance to cover cost-sharing for prescription drugs approved by a commercial insurer without necessitating prior approval from the commissioner or the agency provider help desk. This includes covering prescriptions in quantities exceeding a 34-day supply and those not listed on the preferred drug list, provided the enrollee is subject to a deductible for their commercial insurance. The effective date for these changes is set for January 1, 2026.

Additionally, the bill modifies the authorization process for services covered by third-party payers. It specifies that authorization is not required for the maximum payment amount under medical assistance or in cases of cost-effective prescription drug coverage when the drug is approved by the commercial insurer. This aims to streamline the process for providers and ensure that individuals with commercial insurance can access necessary medications without unnecessary barriers. The effective date for this section is also January 1, 2026.

Statutes affected:
Introduction: 256B.0625