Bill > HF667

This bill clarifies medical assistance (Medicaid) coverage of prescription drugs when an individual has cost-effective health insurance coverage. Specifically, the bill requires medical assistance to cover prescription drug cost-sharing in two key scenarios: (1) when a commercial insurer approves a drug quantity exceeding a 34-day supply, medical assistance must cover the cost-sharing without requiring additional prescriber approval, and (2) when an enrollee is subject to a prescription drug deductible, medical assistance must cover cost-sharing for drugs approved by the commercial insurer, even if the drug is not on the state's preferred drug list. The bill also modifies authorization requirements for third-party insurance coverage, removing the need for authorization when a third-party payer has paid 60% or more of the service cost or when prescription drugs are approved by a commercial insurer for a patient with a deductible. These changes aim to streamline prescription drug coverage and reduce administrative barriers for patients with medical assistance and commercial insurance. The provisions will become effective on January 1, 2026.

Health and Social Services

https://www.revisor.mn.gov/bills/bill.php?b=House&f=HF0667&ssn=0&y=2025