Mid-Year Formulary Bill Passes First House Committee

February 2, 2023

Legislation that limits mid-year formulary changes for patients who are currently on a medication therapy passed through the House Health Finance and Policy Committee on January 31. It was re-referred to the House Commerce Committee. 

Alex Vosooney, MD, president of the Minnesota Academy of Family Physicians (MAFP), testified in strong support of HF 294 (Elkins-DFL, Bloomington) for both the MMA and the MAFP. The bill also limits drug manufacturers from increasing the price of certain drugs once they have posted the price for an entire calendar year. 

“It is infuriating 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 that is working,” Vosooney said in her testimony. “This disruption is frustrating and inconvenient for both patients and providers. It seems unfair that although the patient is locked into a contract with their health plan, changes to the contract might result in them not getting the care that they need. And the patient does not have the opportunity to choose to go to another health plan until the end of his or her enrollment year.”  

The committee also passed another Elkins bill, HF 926, that updates the All-Payer Claims Database (APCD) to include data that is not included in an insurance claim, such as value-based payments. This is a top priority for the MAFP. 

Elkins amended the bill to include two priorities supported by Gov. Tim Walz—expanding the APCD to include dental claims data and data on enrollee race and ethnicity, to the extent it is available. The amendment also allows the commissioner of health to release data that identifies hospitals, clinics, and medical practices, so long as the commissioner finds that data to be accurate, valid, and suitable for publication for each use. 

Finally, the bill requires third-party administrators to annually notify self-insured companies that they can voluntarily submit their payment data to the APCD to ensure the database is as complete as possible. Self-insured companies cannot be forced to submit payment data because of the federal lawsuit protecting ERISA companies, but many employers want to submit their data so they can learn from the research done by the health department. 

A third Elkins-authored bill approved by the committee increases the requirement for hospitals and certain medical practices to publicly report pricing data.  HF 293 expands on current federal requirements for hospitals to publicly report pricing data by specifying the form those reports shall take to ease comparisons by consumers.   

The bill also expands similar price disclosures to outpatient surgical centers, and clinics that derive more than $50 million per year in revenues from diagnostic radiology, diagnostic laboratory testing, orthopedic surgical procedures, ophthalmologic surgical procedures, anesthesia services, oncology services, or dental services.  This new disclosure is delayed until January 1, 2025, to allow the health commissioner to develop rules.