1.1 A bill for an act
1.2 relating to human services;
prohibiting medical assistance coverage of prescription
1.3 drugs solely for weight
loss;amending Minnesota Statutes 2025 Supplement,
1.4 section 256B.0625,
subdivision 13d.
1.5 BE IT ENACTED BY THE
LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes
2025 Supplement, section 256B.0625, subdivision 13d, is
1.7 amended to read:
1.8 Subd. 13d.Drug
formulary. (a) The commissioner shall establish a drug formulary. Its
1.9 establishment and publication
shall not be subject to the requirements of the Administrative
1.10 Procedure Act, but the
Formulary Committee shall review and comment on the formulary
1.11 contents.
1.12 (b) The formulary shall not
include:
1.13 (1) drugs, active
pharmaceutical ingredients, or products for which there is no federal
1.14 funding;
1.15 (2) over-the-counter drugs,
except as provided in subdivision 13;
1.16 (3) drugs or active
pharmaceutical ingredients when used for the treatment of impotence
1.17 or erectile dysfunction;
1.18 (4) drugs or active
pharmaceutical ingredients for which medical value has not been
1.19 established;
1.20 (5) drugs from manufacturers
who have not signed a rebate agreement with the
1.21 Department of Health and Human
Services pursuant to section 1927 of title XIX of the
1.22 Social Security Act; and
2.1 (6) drugs or active
pharmaceutical ingredients when used only for weight loss; and
2.2 (6) (7)
medical cannabis flower as defined in section 342.01, subdivision 54, or
medical
2.3 cannabinoid products as
defined in section 342.01, subdivision 52.
2.4 (c) If a single-source drug
used by at least two percent of the fee-for-service medical
2.5 assistance recipients is
removed from the formulary due to the failure of the manufacturer
2.6 to sign a rebate agreement
with the Department of Health and Human Services, the
2.7 commissioner shall notify
prescribing practitioners within 30 days of receiving notification
2.8 from the Centers for Medicare
and Medicaid Services (CMS) that a rebate agreement was
2.9 not signed.
2.10 (d) Within ten calendar days of
any commissioner determination to change the drug
2.11 formulary, the commissioner
must provide written notice to all enrollees, prescribers, and
2.12 pharmacists affected by the
change. The notice must include a description of the change,
2.13 the reason for the change, and
the date the change will become effective.
2.14 (e) By January 15, 2026, and
annually thereafter, the commissioner of human services
2.15 must provide a report with data
and information related to the effects on enrollees of drug
2.16 formulary changes made in the
prior calendar year to the chairs and ranking minority
2.17 members of the legislative
committees with jurisdiction over health and human services
2.18 policy and finance. The report
must include but is not limited to data and information on:
2.19 (1) the number of times the
formulary was changed;
2.20 (2) the reasons for the
formulary changes and how frequently the formulary was changed
2.21 for each reason;
2.22 (3) the drugs that were removed
from the formulary;
2.23 (4) for each drug that was
removed from the formulary, the number of enrollees who
2.24 were prescribed that drug when
it was removed;
2.25 (5) for each drug that was
removed from the formulary, whether a therapeutically
2.26 equivalent drug was added;
2.27 (6) the drugs that were added
to the formulary;
2.28 (7) the fiscal impacts to the
Department of Human Services resulting from the changes
2.29 to the formulary; and
2.30 (8) enrollee populations or
medical conditions disproportionately affected by the
2.31 formulary changes.
3.1 EFFECTIVE DATE.
This section is effective January 1, 2027, or upon federal approval,
3.2 whichever is later.
