SF1806

SF1806 (Legislative Session 94 (2025-2026))

Certain formulary changes during the plan year prohibition provision and medical assistance program formulary changes implementation for certain enrollees prohibition provision

Related bill: HF1652

AI Generated Summary

This bill, introduced in the Minnesota Senate as S.F. No. 1806, prohibits health plans from making certain formulary changes during a plan year. Specifically, it prevents health plans from removing a previously prescribed drug from their formulary or increasing an enrollee's cost for that drug during the plan year.

Exceptions to this rule include: 1. Cases where the U.S. Food and Drug Administration (FDA) deems a drug unsafe, the drug is withdrawn by the FDA or manufacturer, or independent research warns of previously unknown imminent patient harm. 2. Situations where a brand-name drug is removed or placed in a higher-cost category, but a lower-cost generic or interchangeable equivalent (as rated by the FDA Orange or Purple Books) is added to the formulary. In such cases, a 60-day notice must be provided to prescribers, pharmacists, and affected enrollees.

The bill is intended to ensure stability in prescription drug coverage for enrollees throughout their plan year.

Bill text versions

1st Engrossment PDF file
Introduction PDF file

Actions

Date	Chamber	Where	Type	Name	Committee Name
February 23, 2025	House	Floor	Action	Introduction and first reading
February 23, 2025	Senate	Floor	Action	Introduction and first reading
February 23, 2025	Senate	Floor	Action	Referred to	Commerce and Consumer Protection
February 23, 2025	House	Floor	Action	Referred to	Commerce and Consumer Protection
March 12, 2025	House	Floor	Action	Comm report: To pass as amended and re-refer to	Health and Human Services
March 12, 2025	Senate	Floor	Action	Comm report: To pass as amended and re-refer to	Health and Human Services
March 12, 2025	House	Floor	Action	Author added
March 12, 2025	Senate	Floor	Action	Author added

Citations

[
  {
    "analysis": {
      "added": [
        "Prohibits formulary changes during the plan year for certain enrollees."
      ],
      "removed": [],
      "summary": "This bill amends the medical assistance program's formulary changes regulation under section 256B.0625.",
      "modified": []
    },
    "citation": "256B.0625",
    "subdivision": "subdivision 13"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This section is referenced for the definition of 'drug' related to formulary changes.",
      "modified": []
    },
    "citation": "151.01",
    "subdivision": "subdivision 5"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This section is referenced for the definition of 'enrollee' in the context of health plans.",
      "modified": []
    },
    "citation": "62Q.01",
    "subdivision": "subdivision 2b"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This section is referenced for the definition of 'health plan' related to formulary changes.",
      "modified": []
    },
    "citation": "62Q.01",
    "subdivision": "subdivision 3"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This section is referenced for the definition of 'pharmacy benefit manager'.",
      "modified": []
    },
    "citation": "62W.02",
    "subdivision": "subdivision 15"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This section is referenced for the definition of 'prescription' in relation to health plans.",
      "modified": []
    },
    "citation": "151.01",
    "subdivision": "subdivision 16a"
  }
]