SF 593 modifies the prior authorization process for prescription drugs and creates prescription drug benefit transparency and disclosure requirements.
Section 1 (62M.07), Paragraph (d), specifies that any authorization for a prescription drug must remain valid for the duration of an enrollee’s contract term so long as the drug continues to be prescribed to the patient, the drug remains safe, has not been withdrawn from use by the FDA or the manufacturer, and no drug warnings or recommended changes in drug usage has occurred.
Section 2 (62Q.83) creates prescription drug benefit transparency and management requirements.
Subd. 1 defines the following terms: drug; enrollee contract year; formulary; health plan company; and prescription.
Subd. 2 requires a health plan company that cover prescription drugs and uses a formulary to make its formulary and related benefit information available by electronic means and, upon request, in writing at least 30 days prior to annual renewal dates.
Subd. 3. Paragraph (a), specifies that once a formulary has been established a health plan company, may at any time during an enrollee’s contract year, expand its formulary by adding drugs to the formulary; reduce the copayments or coinsurance; or move a drug to a benefit category that reduces the enrollee’s cost.
Paragraph (b) states that a health plan company may remove a brand name drug from its formulary or place a brand name drug in a benefit category that increases an enrollee’s cost only if a generic or multisource brand name drug rated as therapeutically equivalent or a biological drug rated as interchangeable is added to the formulary at a lower cost to the enrollee and upon 60 notice to prescribers, pharmacists, and affected enrollees.
Paragraph (c) permits a health plan company to change utilization review requirements or move drugs to a benefit category that increases an enrollee’s cost during the enrollee’s contract year upon at least a 60-day notice to prescribers, pharmacists, and affected enrollees, provided that the changes do not apply to enrollees who are currently taking the drugs affected by the changes for the duration of the enrollee's contract year.
Paragraph (d) permits a health plan company to remove drugs from its formulary that have been deemed unsafe by the FDA, or that have been withdrawn by the FDA or the product manufacturer, or when an independent source has issued drug-specific warnings or recommended changes in drug usage.
Section 3 (256B.69, subd. 6) specifies that managed care plans and county-based purchasing plans must comply with chapters 62M and 62Q, for purposes of delivering services under the prepaid medical assistance program.