The bill amends Minnesota Statutes to modify the utilization review process for prescription drug coverage. It introduces new language to define "health benefit plan" to include coverage for prescription drugs, effective January 1, 2026. Additionally, it establishes that any authorization for a prescription drug must remain valid for the duration of an enrollee's contract term, as long as the drug continues to be prescribed for ongoing medication therapy. However, this validity does not apply if the drug is deemed unsafe by the FDA or has been withdrawn by the manufacturer.

Furthermore, the bill revises the conditions under which changes in prior authorization clinical criteria can take effect. It specifies that changes in coverage terms or clinical criteria will not apply until the next plan year for enrollees who have already received prior authorization, with certain exceptions for drugs or services deemed unsafe or harmful. The previous provision allowing for changes in coverage terms when a brand name drug is removed from the formulary has been deleted. The bill aims to enhance patient protection and ensure continuity of care in prescription drug coverage.

Statutes affected:
Introduction: 62M.02, 62M.17