HF1269

Purpose

• Require health plan companies to cover all FDA-approved medical services and prescription medications used to treat or slow the progression of dementia.
• Require coverage for diagnostic testing to determine whether a medical service or medication is appropriate or effective for treating or slowing dementia.
• Prohibit the use of step therapy protocols when providing this dementia coverage.

Main Provisions

• Coverage scope: Health plans must cover every FDA-approved medical service and prescription medication used to treat or slow dementia, as well as related diagnostic tests to assess appropriateness or effectiveness.
• Step therapy ban: Health plans may not apply step therapy (a process that requires trying less expensive or fewer-risk options before more costly or newer treatments) for the dementia-related services and medications described.
• Legal amendments: Makes changes to Minnesota Statutes, including amending section 256B.0625 subdivision 13f and adding new provisions in Minnesota Statutes chapter 62Q (specifically 62Q.546).

Significant Changes to Existing Law

• Broadens required coverage for dementia care by mandating FDA-approved treatments and associated diagnostic testing.
• Restricts the use of step therapy for dementia treatments, limiting insurers’ ability to delay or deny access to dementia therapies.
• Introduces a new statutory provision (62Q.546) to codify these dementia coverage requirements and related protections.

Potential Impacts and Considerations

• Access: Aims to reduce barriers to dementia treatment by ensuring comprehensive coverage and timely access to therapeutics and diagnostics.
• Costs: May affect premium levels and insurer budgeting due to broader coverage requirements.
• Scope: Applies to dementia treatments approved by the FDA; does not mention non-FDA-approved or experimental therapies.

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Relevant Terms dementia, FDA-approved, medical services, prescription medications, diagnostic testing, coverage, health plan company, step therapy, step therapy protocol, 62Q.184 subdivision 1, 62Q.546, Minnesota Statutes, 256B.0625 subdivision 13f, medical assistance