Medical assistance coverage of prescription drugs solely for weight loss prohibited.

A bill for an act

relating to human services; prohibiting medical assistance coverage of prescription

drugs solely for weight loss; amending Minnesota Statutes 2025 Supplement,

section 256B.0625, subdivision 13d.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2025 Supplement, section 256B.0625, subdivision 13d, is

amended to read:

Subd. 13d.

Drug formulary.

(a) The commissioner shall establish a drug formulary. Its

establishment and publication shall not be subject to the requirements of the Administrative

Procedure Act, but the Formulary Committee shall review and comment on the formulary

contents.

(b) The formulary shall not include:

(1) drugs, active pharmaceutical ingredients, or products for which there is no federal

funding;

(2) over-the-counter drugs, except as provided in subdivision 13;

(3) drugs or active pharmaceutical ingredients when used for the treatment of impotence

or erectile dysfunction;

(4) drugs or active pharmaceutical ingredients for which medical value has not been

established;

(5) drugs from manufacturers who have not signed a rebate agreement with the

Department of Health and Human Services pursuant to section 1927 of title XIX of the

Social Security Act;
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and
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(6) drugs or active pharmaceutical ingredients when used only for weight loss; and

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(6)
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(7)
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medical cannabis flower as defined in section
342.01
, subdivision 54, or medical

cannabinoid products as defined in section
342.01, subdivision
52.

(c) If a single-source drug used by at least two percent of the fee-for-service medical

assistance recipients is removed from the formulary due to the failure of the manufacturer

to sign a rebate agreement with the Department of Health and Human Services, the

commissioner shall notify prescribing practitioners within 30 days of receiving notification

from the Centers for Medicare and Medicaid Services (CMS) that a rebate agreement was

not signed.

(d) Within ten calendar days of any commissioner determination to change the drug

formulary, the commissioner must provide written notice to all enrollees, prescribers, and

pharmacists affected by the change. The notice must include a description of the change,

the reason for the change, and the date the change will become effective.

(e) By January 15, 2026, and annually thereafter, the commissioner of human services

must provide a report with data and information related to the effects on enrollees of drug

formulary changes made in the prior calendar year to the chairs and ranking minority

members of the legislative committees with jurisdiction over health and human services

policy and finance. The report must include but is not limited to data and information on:

(1) the number of times the formulary was changed;

(2) the reasons for the formulary changes and how frequently the formulary was changed

for each reason;

(3) the drugs that were removed from the formulary;

(4) for each drug that was removed from the formulary, the number of enrollees who

were prescribed that drug when it was removed;

(5) for each drug that was removed from the formulary, whether a therapeutically

equivalent drug was added;

(6) the drugs that were added to the formulary;

(7) the fiscal impacts to the Department of Human Services resulting from the changes

to the formulary; and

(8) enrollee populations or medical conditions disproportionately affected by the

formulary changes.

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EFFECTIVE DATE.

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This section is effective January 1, 2027, or upon federal approval,

whichever is later.

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