Legislation Preserving Access to Needed Prescription Drugs Heard in House Committee

March 24, 2022

A bill that prevents insurers and pharmacy benefit managers (PBMs) from forcing a patient to change to a new medication during the contract year once a therapy has begun was heard in the House Health Finance and Policy Committee this week. This is one of the MMA’s top legislative priorities this session. 

Nothing in current law prohibits insurers and PBMs from changing their drug formulary or preferred drug list at any time during the year, a practice sometimes referred to as “non-medical switching.” Yet, an enrollee in a health plan is bound to remain in that health plan for the remainder of their enrollment year. This legislation would protect patients by prohibiting insurers from the practice of non-medical switching for an enrollee who has started a drug therapy that is working.  

The legislation (HF58, Rep. Steve Elkins-DFL, Bloomington) addresses four key points. First, it requires drug manufacturers to annually report their drug prices and only increase those prices if they provide the Commissioner of Commerce a 90-day notice. Second, it requires insurers and PBMs to use a real-time prescription benefit tool that is being developed by the National Council for Prescription Drug Programs (NCPDP). This tool would inform prescribers in real-time what drugs are covered. Third, it requires insurers to provide a 60-day notice to prescribers, pharmacists, and enrollees prior to making any changes to the utilization review requirements related to drug coverage. And finally, the bill prohibits insurers or PBMs from forcing patients who are taking a covered medication to another medication through the remainder of their contract year. 

This bill does not prohibit PBMs from changing their formularies throughout the year. Insurers and PBMs would still be allowed to add new drugs if desired and add new generic brands when they become available. They will be able to add new drugs that may be more cost-effective for a patient. PhRMA, America’s Health Insurance Plans, the Association for Accessible Medicines representing generic and biosimilar manufacturers, the Pharmaceutical Care Management Association, and the Minnesota Chamber of Commerce submitted testimony in opposition, arguing mid-year formulary changes are necessary to manage healthcare costs. 

The legislation was laid over for inclusion in the House Health and Human Services omnibus bill.