Bill > SF1876

This bill requires pharmacy benefit managers (PBMs) and health carriers to include lower-cost drugs in their formularies and structure their formulary tiers to prioritize drugs with the lowest out-of-pocket costs for patients. Specifically, if a PBM or health carrier includes a brand-name drug in its formulary, it must also include the equivalent generic drug with a lower wholesale acquisition cost. Similarly, for biological drugs, if a brand-name biologic is included, the carrier must also include the equivalent biosimilar with a lower cost. The bill mandates that when new generic or biosimilar drugs are approved by the FDA and have a lower cost, they must be immediately added to the formulary. The formulary must be structured to give preference to drugs with the lowest out-of-pocket costs for patients, and carriers cannot impose additional barriers like prior authorization or step therapy requirements for these lower-cost drugs. An exception exists for plans where the patient's cost-sharing is $25 or less for generic drugs and $55 or less for brand-name drugs. The provisions of this bill will take effect on January 1, 2026, and aim to make prescription drugs more affordable by encouraging the use of lower-cost alternatives.

Business and Industry, Health and Social Services

https://www.revisor.mn.gov/bills/bill.php?b=Senate&f=SF1876&ssn=0&y=2025