Prior authorization of drugs the enrollee has been prescribed prohibition for at least six months

A bill for an act

relating to health insurance; prohibiting prior authorization of drugs the enrollee

has been prescribed for at least six months; amending Minnesota Statutes 2024,

section 62M.07, subdivision 2.

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

Section 1.

Minnesota Statutes 2024, section 62M.07, subdivision 2, is amended to read:

Subd. 2.

Prior authorization of certain services prohibited.

No utilization review

organization, health plan company, or claims administrator may conduct or require prior

authorization of:

(1) emergency confinement or an emergency service. The enrollee or the enrollee's

authorized representative may be required to notify the health plan company, claims

administrator, or utilization review organization as soon as reasonably possible after the

beginning of the emergency confinement or emergency service;

(2) outpatient mental health treatment or outpatient substance use disorder treatment,

except for treatment which is a medication. Prior authorizations required for medications

used for outpatient mental health treatment or outpatient substance use disorder treatment

must be processed according to section
62M.05, subdivision 3b
, for initial determinations,

and according to section
62M.06, subdivision 2
, for appeals;

(3) antineoplastic cancer treatment that is consistent with guidelines of the National

Comprehensive Cancer Network, except for treatment which is a medication. Prior

authorizations required for medications used for antineoplastic cancer treatment must be

processed according to section
62M.05, subdivision 3b
, for initial determinations, and

according to section
62M.06, subdivision 2
, for appeals;

(4) services that currently have a rating of A or B from the United States Preventive

Services Task Force, immunizations recommended by the Advisory Committee on

Immunization Practices of the Centers for Disease Control and Prevention, or preventive

services and screenings provided to women as described in Code of Federal Regulations,

title 45, section 147.130;

(5) pediatric hospice services provided by a hospice provider licensed under sections

144A.75
to
144A.755
;
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and
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(6) treatment delivered through a neonatal abstinence program operated by pediatric

pain or palliative care subspecialists
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; and
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(7) drugs prescribed for, and used on an ongoing basis by, the enrollee for the immediately

preceding six months
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.

Clauses (2) to
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(6)
deleted text end
new text begin
(7)
new text end
are effective January 1, 2026, and apply to health benefit plans offered,

sold, issued, or renewed on or after that date.