This bill establishes a prior authorization commission within the Minnesota Department of Health, tasked with reviewing medications that frequently face prior authorization denials and recommending specific medications for exemption from prior authorization requirements. The commission will consist of nine members from various health and commerce sectors, including representatives from the Department of Health, Department of Commerce, and the Minnesota Prescription Drug Affordability Board, as well as a physician and representatives from health plans and pharmacy benefit managers. The commission's recommendations will be based on criteria such as medication cost, utilization, coverage, effectiveness, and medical necessity.

Additionally, the bill amends Minnesota Statutes 2024, section 62M.07, to prohibit prior authorization for certain services and medications. Notably, it adds a provision that allows the commissioner of health to approve medications for inclusion in the prior authorization prohibition. The bill specifies that the commission must submit an annual report detailing its analysis and recommendations, and by August 1, 2027, the commissioner must approve one medication for this exemption based on the commission's recommendations. The changes are set to take effect for health benefit plans offered or renewed on or after January 1, 2026.

Statutes affected:
Introduction: 62M.07