Bill > SF1509

This bill modifies Minnesota's medical assistance (Medicaid) program to expand coverage for prescription drugs and medical services when a recipient has a primary third-party health insurance payer. Specifically, the bill requires medical assistance to cover any drug that is on the formulary of the recipient's primary third-party payer, even if the drug is not typically included in the medical assistance formulary, and mandates that this coverage be provided without requiring prior authorization and regardless of the payment amount initially covered by the primary insurance. Additionally, the bill stipulates that medical assistance must cover medical services that a primary third-party payer considers out-of-network or requiring referral, as long as those services would be considered in-network and do not require a referral under medical assistance. The changes aim to ensure that Medicaid recipients can access necessary medications and services more easily, even when they have other health insurance coverage. These modifications represent an effort to reduce barriers to healthcare access and provide more comprehensive coverage for individuals enrolled in medical assistance programs.

Health and Social Services

https://www.revisor.mn.gov/bills/bill.php?b=Senate&f=SF1509&ssn=0&y=2025