This bill, Minnesota Senate File No. 2392, seeks to expand the mental health carve-out from prior authorization requirements under the state's Medicaid program. It does this by amending Minnesota Statutes 2024, section 256B.0625, subdivision 13f.

Key Provisions of the Bill:

1. Prior Authorization Review Process

   • The Formulary Committee is responsible for reviewing and recommending drugs that require prior authorization.
   • The commissioner must provide data on potential impacts to patient care and program costs before adding any drug to prior authorization.
   • The public is allowed 15 days to comment before any prior authorization is implemented.

2. Expanded Mental Health Exemptions

   • No prior authorization or utilization management controls can be applied to:
     • Atypical antipsychotics
     • Anticonvulsants
     • Antidepressants
     • Antipsychotics
     • Non-controlled substance anti-anxiety medications
       
   • The exemption applies if no generic equivalent exists or if the medication was part of a patient’s treatment before July 1, 2003, or remains part of their current treatment.

3. Protections for Mental Health Medications

   • Automatic 60-day prior authorization approval for brand-name mental health drugs prescribed within 60 days of a generic becoming available.
   • The exemption applies to multistate preferred drug lists or supplemental rebate programs administered by the commissioner.

4. Liquid Methadone & Oral Liquid Medications

   • No prior authorization for liquid methadone if only one version is available.
   • If multiple liquid methadone versions exist, the commissioner must ensure one version is available without prior authorization.
   • Oral liquid drugs:
     
     • Automatic approval within 24 hours for FDA-approved conditions if the patient requires enteral tube feeding.
     • The commissioner can choose a preferred liquid version for automatic approval.

5. New FDA-Approved Drugs

   • Automatic 180-day prior authorization period for any drug approved by the FDA on or after July 1, 2005.
   • After 180 days, the drug must be reviewed under the standard process.

6. Step Therapy & Prior Authorization Standards

   • Any step therapy protocols must comply with Minnesota Statute 62Q.1841.
   • No prior authorization or step therapy requirements for HIV/AIDS drugs.

Impact of the Bill

• The bill reduces barriers for patients receiving mental health medication by expanding exemptions from prior authorization.
• It ensures continuous access to critical psychiatric drugs while maintaining some oversight on cost and utilization.
• Patients using liquid formulations of medications or requiring enteral tube administration will have faster approvals.

Next Steps

• The bill was introduced on March 10, 2025, and referred to the Health and Human Services Committee for further consideration.