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S.F. 3019 establishes an affordable patient insulin assistance program that includes access to emergency insulin and access to ongoing insulin supply options including a long term patient insulin assistance program. S.F. 3019 also requires health plan companies and group health plans to provide notice to enrollees with dependent child coverage when the coverage is about to terminate. S.F. 3019 also requires MNsure to conduct a public awareness campaign to create awareness of the patient insulin assistance program.
Section 1 (62Q.678) requires group health plans and health plan companies to provide written notice to enrollees with dependent child coverage that the dependent’s child’s coverage ends when the child reaches the age of 26. The notice must be sent at least 90 days before the child reaches the age of 26 and must include the date on which coverage ends and information on accessing the MNsure website.
Section 2 (62V.15) creates the patient insulin assistance program which establishes access to emergency insulin and to a long term Minnesota assistance program.
Subdivision 1 requires the program to be implemented by July 1, 2020 and requires the program to provide access to emergency insulin and to ongoing insulin options.
Subdivision 2, paragraph (a) establishes eligibility for the emergency program and for the assistance program. An individual is eligible if the individual:
- is a resident of Minnesota with a valid identification card that indicates residency;
- has family income that is equal to or less than 400 percent of FPG;
- is not enrolled in medical assistance or MinnesotaCare;
- is not eligible to receive health care through Indian Health services, Tricare, or prescription drug benefits though the Department of Veteran Affairs;
- does not have access to prescription drug coverage through an individual or group health plan that limits the total amount of cost sharing for insulin to $100 or less for a 30 day supply of insulin;
- is not receiving insulin through a manufacturer’s patient assistance program; and
- has not received emergency insulin though this program within the 12 months preceding the application date.
Paragraph (b) states that an individual who is enrolled in Medicare and meets the requirements in paragraph (a) may be eligible for emergency insulin if the individual and the individual’s drug plan have incurred prescription drug costs during the calendar year of application in an amount that meets the coverage gap spending threshold established under Medicare, and does not have access to insulin for less than $100 for a 30 day supply.
Subdivision 3, paragraph (a) requires MNsure to develop an application form for the patient insulin assistance program and make the application form accessible to individuals through MNsure’s website.
Paragraph (b) requires the application to include the applicant’s income, residency status, and insurance status, and if the applicant is in need of emergency insulin and whether the individual is also applying for the long term insulin assistance program.
Paragraph (c) states that if an individual signs the application the individual is attesting that the information in the application is correct and consents to MNsure submitting the individual’s information to insulin manufacturers and to MNsure processing the application.
Paragraph (d) requires MNsure to submit the applicant’s name and contact information to each insulin manufacturer for the purpose of informing the manufacturer that the individual may be eligible for the manufacturer’s patient assistance program.
Paragraph (e) specifies that if an individual submits a signed application that contains information that the individual knows is false or willfully misleading the individual may be subject to section 256.98. (wrongfully obtaining assistance)
Subdivision 4, paragraph (a) requires MNsure to provide to an applicant requesting emergency insulin with an identification number and any information necessary for the pharmacy to dispense insulin on an emergency basis.
Paragraph (b) After completing paragraph (a), MNsure is required to review each application within five business days of receipt of the application. If the applicant attests to being on Medicare, MNsure must provide the individual with information for the Senior LinkAge Line and the manufacturers’ patient assistance programs. If the individual is not on Medicare, MNsure must connect the individual with a navigator.
Paragraph (c) permits MNsure to contract with a third party administrator to implement this subdivision and a claims adjudicator to process claims and reimburse pharmacies for emergency insulin dispensed through this program. Reimbursement to the pharmacies must be in an amount that at least covers the pharmacy’s acquisition cost of the insulin.
Subdivision 5, paragraph (a) requires the individual seeking emergency insulin to present to the pharmacy the identification number provided by MNsure, a valid prescription, and any other information required to process the claim.
Paragraph (b) specifies that before insulin is dispensed, the individual must provide the pharmacy with identification indicating Minnesota residency.
Paragraph (c) requires the pharmacy to dispense a 30 day supply of insulin once paragraphs (a) and (b) have been met.
Paragraph (d) requires the individual to pay an insulin copayment to the pharmacy of $75 for a 30 day supply.
Subdivision 6, paragraph (a) requires a navigator to contact an individual who has submitted an application and whose name was received by the navigator from MNsure.
Paragraph (b) requires the navigator to first determine whether the individual is eligible for medical assistance or MinnesotaCare and, if eligible, to assist the individual in applying for the appropriate program.
Paragraph (c) If the individual is not eligible for medical assistance or MinnesotaCare, requires the navigator to provide the individual with information and assistance on sources of ongoing insulin coverage including information on qualified health plans, the 340B program, community health centers, manufacturer patient assistance programs, and the Minnesota assistance program.
Paragraph (d) If an individual is cooperating in enrolling in medical assistance, MinnesotaCare, or the Minnesota assistance program, a navigator is authorized to inform MNsure and MNsure shall provide the individual with a new identification number to provide to a pharmacy for an additional 30 day supply of emergency insulin.
Subdivision 7, paragraph (a) requires MNsure to continue to process an individual’s application to determine whether the individual is eligible for Minnesota assistance program.
Paragraph (b) If an individual is eligible for the Minnesota assistance program, MNsure is required to provide the individual with an eligibility statement indicating eligibility, a unique patient identification number, and information instructing the individual to take the statement to their health care practitioner.
Paragraph (c) specifies that the eligibility statement is valid until the last day of the next open enrollment period offered through MNsure and that an individual may only access the assistance program once.
Subdivision 8, paragraph (a) requires all primary care physicians and endocrinologists licensed and practicing within the state to participate in the Minnesota assistance program.
Paragraph (b) requires the health care practitioner to submit the individual’s eligibility statement, unique identification number, and the name and daily dosage amount prescribed to the appropriate manufacturer.
Paragraph (c) requires the practitioner to submit with the order: the practitioner’s name and address; state license number, expiration date, and NPI number; contact information; and any specific days or times when deliveries are not accepted by the practitioner.
Paragraph (d) Upon receipt of the insulin from the manufacturer, the practitioner must provide the insulin to the patient at no cost to the patient and must not provide the insulin to any other patient or seek third-party reimbursement for the insulin.
Paragraph (e) authorizes the practitioner to charge a patient a copayment for administration services not to exceed $25 for each 90 day supply of insulin sent to the practitioner.
Paragraph (f) authorizes the practitioner to submit to a manufacturer a reorder of insulin if the eligibility statement has not expired.
Subdivision 9, paragraph (a) requires each insulin manufacturer licensed under chapter 151 to participate in the Minnesota assistance program and must provide MNsure with contact information.
Paragraph (b) requires a manufacturer, upon receipt of an order from a practitioner, to send to the practitioner a 90-day supply of insulin as ordered at no charge to the practitioner or patient.
Paragraph (c) requires a manufacturer to send to a practitioner an additional 90 day supply upon receipt of a reorder at no charge to the practitioner or patient.
Paragraph (d) authorizes the manufacturer to send the insulin to the patient if the manufacturer provides a mail order option.
Subdivision 10 authorizes the commissioner of human services and the Board of Directors of MNsure to enter into a data sharing agreement for purposes of determining eligibility for the patient insulin assistance program.
Subdivisoin 11, paragraph (a) requires each insulin manufacturer to annually report to the board of pharmacy the following:
- the number of Minnesota residents receiving insulin through the manufacturer’s patient assistance program in the preceding calendar year;
- the number of individuals receiving insulin from the manufacturer though the Minnesota assistance program in the preceding calendar year; and
- the value of the insulin provided by the manufacturer under (1) and (2).
Paragraph (b) requires the board of pharmacy to submit the information in paragraph (a) to the legislature.
Paragraph (c) requires MNsure to annually submit a report to the legislature the following:
- the number of individuals who applied to the patient insulin assistance program in the preceding calendar year;
- the number of individuals who accessed emergency insulin through the program in the preceding calendar year; and
- the number of individuals who participated in the Minnesota assistance program in the preceding calendar year.
Section 3 (151.06, subdivision 6) requires information on the insulin patient assistance program to be added to the information provided on the Board of Pharmacy’s website.
Section 4 (214.122) requires the Boards of Medical Practice and Nursing to ensure that licensees are provided with information on the insulin patient assistance program.
Section 5 requires MNsure to conduct a public awareness campaign to create awareness on the patient insulin assistance program.
Section 6 appropriates money.
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