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HF1076 (Legislative Session 94 (2025-2026))

Pharmacy benefit managers and health carriers required to include lower-cost drugs in their formularies, and formulary structure and formulary tiering for each health plan required to give preference to the drug with the lowest out-of-pocket cost to the patient.

Related bill: SF1876

AI Generated Summary

House File No. 1076 is a proposed legislative bill aimed at ensuring patients in Minnesota have access to more affordable prescription drugs. The key provisions of the bill are:

  1. Inclusion of Lower-Cost Drugs in Formulary: Pharmacy benefit managers (PBMs) and health carriers are required to include the lowest-cost equivalent drugs in their formularies. This includes:

    • Generic drugs when a brand name drug is listed and vice versa, provided the wholesale acquisition cost of the generic or brand name alternative is lower than the one currently listed.
    • Biosimilars when a brand name biologic is listed and vice versa under the same cost conditions.

  2. Lower-Cost New Drugs: When a new generic drug or biosimilar is approved by the FDA and it is less expensive than the lowest-cost equivalent already included in the formulary, the PBMs or health carriers must add it to the formulary immediately.

  3. Formulary Structure and Tiering: The structure of the formularies and any tiering system must prefer drugs (both brand name and generic or equivalent biologics and biosimilars) that have the lowest out-of-pocket costs for patients. Additionally, the bill restricts PBMs and health carriers from imposing authorization, step therapy, or other limitations that hinder access to the lowest-cost options.

The intent of this bill is to provide financial relief to patients by prioritizing more cost-effective medication options, thereby potentially reducing the overall healthcare expenses for both patients and insurance systems. This can help ensure that medication is both accessible and affordable, supporting better health outcomes.

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
February 16, 2025HouseFloorActionIntroduction and first reading, referred toHealth Finance and Policy
February 19, 2025HouseFloorActionAuthor added
March 12, 2025HouseFloorActionAuthor added
March 19, 2025HouseFloorActionAuthor added
April 01, 2025HouseFloorActionAuthor added

Citations

 
[
  {
    "analysis": {
      "added": [
        "New section coding for definition of 'Biologic'."
      ],
      "removed": [],
      "summary": "This bill defines 'Biologic', 'Wholesale acquisition cost', and 'Out-of-pocket cost' with reference to sections within chapter 62J.",
      "modified": []
    },
    "citation": "62J.86"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This bill uses existing definitions for 'Biosimilar', 'Brand name drug' and 'Generic drug' by referencing section 62J.84.",
      "modified": []
    },
    "citation": "62J.84"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Defines 'Health plan' as referenced in section 62A.011.",
      "modified": []
    },
    "citation": "62A.011"
  },
  {
    "analysis": {
      "added": [
        "A new subsection clarifying disbursement rules."
      ],
      "removed": [
        "Eliminates previous requirement for municipal matching funds."
      ],
      "summary": "This bill modifies pension fund eligibility for volunteer firefighters under section 353G.06.",
      "modified": [
        "Adjusts pension payment schedule from annual to quarterly."
      ]
    },
    "citation": "353G.06"
  }
]

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