MMA’s Prior Authorization Reform Bill Prioritized Early in St. Paul

February 15, 2024

The MMA’s top legislative priority, fixing prior authorization (HF3578), was the first bill heard in the House Health Finance and Policy Committee, when the second biennium of the legislative session kicked off in St. Paul this week. 

MMA President Laurel Ries, MD, testified during the committee hearing, which took place on February 15. “Prior authorization often gets in the way of accessing the best care for my patients,” Ries told the committee. “House file 3578 is designed to limit prior authorization hassles to ensure patients get the care they need.” 

MMA President Laurel Ries, MD, testifies on behalf of HF 3578 during a February 15 committee hearing.

In her opening remarks before the committee, the bill’s chief author, Rep. Kristen Bahner (DFL – Maple Grove) said: “Prior authorization, also called prior auth, is not a new issue. It is an issue most of us have either experienced personally or have heard from constituents who have experienced it. “ 

The legislation prohibits prior authorization for services that are too important to delay. Specifically, the language prohibits prior authorization for: 

• Medications to treat a substance use disorder, 
• Outpatient mental health treatment, 
• Treatments to fight cancer consistent with national cancer-care guidelines, 
• Generic drugs deemed therapeutically equivalent by the FDA, 
• Preventive services recommended by the U.S. Preventive Services Task Force, 
• Pediatric hospice services and neonatal abstinence programs, and 
• Treatments covered through value-based arrangements. 

Additionally, the legislation limits approvals for chronic conditions to one-time only and directs the Minnesota Commissioner of Commerce to develop a “gold card” program for physicians with prior authorization approval rates above the 70th percentile.  

The legislation also requires insurers to annually report to the Minnesota Department of Commerce how often they use prior authorization, how often they deny services, and how often they approve services. It also aims to eliminate retrospective denials and includes language to require insurers to retain automatic processing ability. 

In addition to Ries’ testimony, Maureen Alderman, a member of the Minnesota Rare Disease Council and mother of a child with a rare chronic condition, shared her story with the committee. 

"If my daughter gets sick and her ammonia gets high, it isn’t weeks that we could see impacts. It is hours, and our physician has told us it truly could be only minutes. Without her medication, instead of playing in our yard with her big brother, she could be in a coma in the hospital,” Alderman said. “To be honest with you today, this isn’t something I even let my mind go to normally because no parent should have to think about what to do if you cannot access the drug you know is saving your child’s life due to a prior authorization requirement.” 

HF3578 passed on a strong voice vote and was referred to the House Commerce Finance and Policy Committee. 

“If this legislation passes, Minnesota will have the most patient-friendly prior authorization laws in the nation,” said MMA CEO Janet Silversmith. “It is our top legislative priority.” 

The House bill’s companion, SF3532, was introduced in the Senate this week by Sen. Kelly Morrison, MD, (DFL – Deephaven) and was referred to the Senate Commerce and Consumer Protection Committee. 

On February 12, the MMA sent out an Action Alert to members urging them to contact their legislator on this legislation. If you haven’t sent an alert yet, please do so here.