MMA Priority Bill on Mid-Year Formularies Receives First Committee Hearing

March 13, 2025

Legislation to limit mid-year formularies, an MMA priority, was heard in the Senate Commerce and Consumer Protection Committee on March 11. 

Currently, insurance companies and pharmacy benefit managers (PBMs) can change a patient’s drug coverage at any point in the insurance contract year. The MMA has opposed this practice because many patients choose their health insurance plan based on whether the plan covers needed medications. Changes can lead to delays in care, unexpected and increased expenses, and overall worse health outcomes for patients. SF 1806 (Mann – DFL, Edina), would limit when mid-year formulary changes can occur. 

The legislation would not prohibit all mid-year formulary changes, but would only limit them for patients currently using a medication. Nothing in the bill would prohibit PBMs and insurers from changing formularies for all other enrollees. The legislation also allows a change if the health plan offers a generic drug rated as therapeutically equivalent to the drug subject to the formulary change. 

“Senate File 1806 says health plans can change their formulary whenever they want, as often as their heart desires, but if a patient is on a medication, they can stay on that one medication until the end of the year,” said Sen. Alice Mann, MD, the bill’s author. “It is a patient protection issue. We cannot pull the rug out from under patients anymore and expect good patient health outcomes.” 

The Minnesota Council of Health Plans opposes the legislation, arguing that even limiting formulary changes for individuals will lead to an increase in premiums.  

The bill was referred to the Senate Health and Human Services Committee. The bill’s House companion, HF 1652 (Elkins, DFL – Bloomington) has yet to receive a committee hearing.