This bill aims to enhance protections for enrollees in health plans by prohibiting certain formulary changes during the plan year. Specifically, it mandates that health plans cannot remove a drug from their formulary or increase 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 Exceptions to this rule include situations where a drug is deemed unsafe by the FDA, withdrawn by the FDA or manufacturer, or when there are imminent patient harm warnings from credible sources. 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 to ensure that the medical assistance program continues to cover drugs for enrollees who were previously prescribed those drugs, even if they are removed from the formulary, until the end of the calendar year following the removal. Similar exceptions apply regarding safety and cost-equivalence as outlined for health plans. The effective date for these provisions is set for January 1, 2026, or upon federal approval, whichever comes later.

Statutes affected:
1st Engrossment: 256B.0625