Limits on Mid-Year Formulary Changes Passed House Commerce Committee

February 16, 2023

Legislation to limit insurers and pharmacy benefit managers (PBMs) from forcing patients to change their medication during their enrollment contract year passed another House committee on February 13. 

The House Commerce Finance and Policy Committee heard HF 294 (Elkins, DFL-Bloomington), legislation that would allow patients to stay on a medication that is working through the end of the enrollment year, even if the insurer or PBM changes their formulary because they received a better deal from the drug manufacturer. 

“There is nothing more infuriating than when I have a patient stabilized on a medication that is working for her, and I hear the insurer or PBM changes its formulary, forcing my patient to change from the medication,” said Nicole Chaisson, MD, testifying in support of the bill.   

For many conditions, changing from one drug to another in the same class works fine for a patient. But for certain conditions, like mental illness, epilepsy, multiple sclerosis, and others, changing medication mid-treatment can put a patient at risk for serious harm. 

HF 294 does not prohibit PBMs from changing formularies throughout the year. They can always add new drugs when they believe there is benefit as well as add a new generic when it comes available. PBMs can also add new drugs that may be more cost-effective for a patient.  

This bill prohibits forcing a patient to switch drugs once they have started a therapy that was originally covered by the PBM. Patients will be able to remain on their effective drugs throughout the enrollment year.  

The Senate companion, SF 328 (Mann, DFL-Bloomington), is awaiting a hearing in the Senate Health and Human Services Committee.