This bill aims to enhance protections for enrollees in health plans by prohibiting certain 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 Exceptions to this rule include situations where a drug is deemed unsafe by the FDA, withdrawn by the FDA or manufacturer, or when there are urgent warnings about the drug's use. Additionally, if a health plan replaces a brand-name drug with a therapeutically equivalent generic or multisource brand drug at a lower cost, they may remove the brand-name drug from the formulary, provided they give at least 60 days' notice to prescribers, pharmacists, and affected enrollees.

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 January 1 of the following year. Similar to the health plan provisions, there are exceptions for drugs deemed unsafe, withdrawn, or subject to urgent warnings. The effective date for these changes is set for January 1, 2026, or upon federal approval, whichever is later.

Statutes affected:
1st Engrossment: 256B.0625