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HF2533 (Legislative Session 94 (2025-2026))

Prior authorization mental health carve out expanded.

Related bill: SF2392

AI Generated Summary

Purpose of the Bill

The bill aims to amend Minnesota laws concerning the process of prior authorization for certain medications, specifically focusing on exceptions involving mental health medications and the handling of drugs used for HIV and AIDS treatment. This is to ensure that patients have better access to necessary medicines without unnecessary delays.

Main Provisions

  • Prior Authorization Expansion: The bill outlines conditions under which prior authorization for medications can be required by the commissioner and when it should be automatically granted.
  • Mental Health Medications: The bill prohibits the requirement of prior authorization for atypical antipsychotics and other central nervous system medications, such as anticonvulsants and antidepressants, used in mental illness treatment, provided certain conditions are met, like no generic equivalent being available or the drug being part of the patient's ongoing treatment.
  • Liquid Methadone: The bill mandates that at least one version of liquid methadone must be available without prior authorization if multiple versions exist.
  • Oral Liquid Forms: For patients using enteral tubes, prior authorization requests for oral liquid drugs must be approved within 24 hours.
  • New Drug Approvals: For new drugs approved by the FDA after July 1, 2005, the bill allows automatic prior authorization for up to 180 days after their market release.
  • Expedited Process: A streamlined prior authorization form is required for patients needing oral liquid forms of medication via enteral tubes.
  • HIV and AIDS Medications: Prior authorization or step therapy is not required for drugs approved by the FDA for HIV and AIDS treatment.

Significant Changes to Existing Law

  • Mental Health Carve-Out: Extends and clarifies the exemptions for mental health medications from prior authorization procedures.
  • Simplification for Patients with Special Needs: Introduces faster approval procedures for medications taken through enteral feeding.
  • Ensuring Access to New Treatments: Establishes a temporary automatic prior authorization timeline for new FDA-approved drugs to facilitate their quick use once available.

Relevant Terms

prior authorization, mental health medications, antipsychotics, anticonvulsants, antidepressants, enteral tube, liquid methadone, new drug approvals, HIV treatment, AIDS treatment.

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
March 19, 2025HouseFloorActionIntroduction and first reading, referred toHuman Services Finance and Policy
March 23, 2025HouseFloorActionMotion to recall and re-refer, motion prevailedHealth Finance and Policy

Citations

 
[
  {
    "analysis": {
      "added": [
        "The Formulary Committee can recommend drugs for prior authorization directly to the commissioner."
      ],
      "removed": [
        "The elimination of prior authorization requirements for atypical antipsychotic drugs when no generic is available, if initially prescribed before July 1, 2003."
      ],
      "summary": "The bill addresses the use of prior authorization for certain drugs under Medicaid, as stipulated in section 256B.0625, subdivision 13f.",
      "modified": [
        "Adjustments in utilizing prior authorization for oral liquid forms of drugs when prescribed for FDA-approved conditions."
      ]
    },
    "citation": "256B.0625",
    "subdivision": "13f"
  },
  {
    "analysis": {
      "added": [
        ""
      ],
      "removed": [
        ""
      ],
      "summary": "The bill touches on prescription requirements concerning brand name drugs when a generic is available, under section 151.21, subdivision 2.",
      "modified": [
        "Provision allowing the commissioner to require prior authorization for brand name drugs even if the prescriber specifies 'dispense as written'."
      ]
    },
    "citation": "151.21",
    "subdivision": "2"
  },
  {
    "analysis": {
      "added": [
        ""
      ],
      "removed": [
        ""
      ],
      "summary": "The bill maintains compliance with section 62Q.184 in the provision of prior authorizations.",
      "modified": [
        "Ensures compliance for prior authorization processes in Medicaid's drug formulary."
      ]
    },
    "citation": "62Q.184",
    "subdivision": ""
  },
  {
    "analysis": {
      "added": [
        ""
      ],
      "removed": [
        ""
      ],
      "summary": "The bill aligns step therapy protocol requirements with section 62Q.1841.",
      "modified": [
        "Mandates compliance with existing step therapy protocol standards."
      ]
    },
    "citation": "62Q.1841",
    "subdivision": ""
  }
]

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