This bill aims to enhance the stability of prescription drug coverage for enrollees in health plans and the medical assistance program by prohibiting formulary changes during the plan year. Specifically, it prevents health plans from removing drugs from their formulary or increasing the cost of a drug for enrollees who have been prescribed that drug during the plan year. Exceptions to this rule include situations where a drug is deemed unsafe by the FDA, withdrawn by the FDA or manufacturer, or when there are imminent patient safety concerns based on independent research. Additionally, if a health plan replaces a brand name drug with a therapeutically equivalent generic or multisource drug at a lower cost, they may make formulary changes, provided they give at least 60 days' notice to affected parties.

The bill also amends Minnesota Statutes 2024, section 256B.0625, to ensure that medical assistance covers drugs for enrollees who were previously prescribed a drug that has been removed from the formulary, maintaining coverage at the same level until the following calendar year. Similar to health plans, there are exceptions for drugs deemed unsafe or withdrawn, and for brand name drugs replaced with generics or equivalent drugs at the same or lower cost, with the same notice requirements. The provisions of this bill are set to take effect on January 1, 2026, or upon federal approval, whichever is later.

Statutes affected:
1st Engrossment: 256B.0625