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HF2533 (Legislative Session 94 (2025-2026))

Prior authorization mental health carve out expanded.

Related bill: SF2392

AI Generated Summary

Purpose of the Bill

The bill aims to expand and clarify the regulations around prior authorization for mental health drugs in the state of Minnesota. This involves managing how and when certain prescription drugs, particularly those related to mental health treatments, require prior approval before they can be covered under Medicaid.

Main Provisions

  • Review Role: The Formulary Committee is tasked with reviewing and recommending which drugs should require prior authorization. This includes establishing criteria for considering whether brand-name drugs need approval when generics are available.
  • Public Involvement: Before imposing prior authorization on a drug, the commissioner must provide data on its potential impact and conduct a public forum for comments, delaying implementation until 15 days after these steps.
  • Exemptions for Mental Health Drugs: Certain mental health-related drugs, such as atypical antipsychotics, anticonvulsants, antidepressants, and non-controlled antianxiety drugs, are exempt from prior authorization if no generics are available, the drug was prescribed before July 1, 2003, or if it's part of an ongoing treatment.

Significant Changes

  • Expansion of Exemptions: The bill expands exemptions for mental health medications from prior authorization requirements. It ensures continued access to needed medications without bureaucratic delays.
  • Prior Authorization Clarity: A distinction is made for medications newly approved by the FDA. Automatic prior authorization can be enforced for up to 180 days post-approval, ensuring temporary control while thorough evaluations are conducted.
  • Streamlined Processes for Liquid Forms: Processes are improved for oral liquid drugs needed by patients with enteral feeding tubes, requiring fast-track approvals under specified conditions.
  • HIV and AIDS Medications: A clear mandate is made that HIV and AIDS drugs are exempt from step therapy and prior authorization, ensuring timely patient access.

Relevant Terms

prior authorization, mental health carve out, Formulary Committee, brand-name drugs, generic drugs, atypical antipsychotics, anticonvulsants, antidepressants, antianxiety drugs, enteral tube, FDA, Medicaid, HIV, AIDS

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
March 19, 2025HouseFloorActionIntroduction and first reading, referred toHuman Services Finance and Policy
March 23, 2025HouseFloorActionMotion to recall and re-refer, motion prevailedHealth Finance and Policy
March 23, 2025HouseFloorActionMotion to recall and re-refer, motion prevailedHealth Finance and Policy

Citations

 
[
  {
    "analysis": {
      "added": [
        "New rules for automatic approval of prior authorization for drugs prescribed for patients using enteral tubes."
      ],
      "removed": [
        "Restrictions on prior authorization for specific drug classes are shifted to ensure faster access to necessary medications."
      ],
      "summary": "This bill modifies the prior authorization requirements for certain medications under section 256B.0625. The changes primarily affect mental health medications and those prescribed via enteral tubes.",
      "modified": [
        "Expands exceptions for prior authorization for atypical antipsychotic and certain mental health drugs."
      ]
    },
    "citation": "256B.0625"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This bill references section 151.21 in relation to prescription drug dispensing requirements, ensuring that generic versions are considered.",
      "modified": [
        "Clarification on prior authorization requirements when a generic is available, despite a dispense as written instruction."
      ]
    },
    "citation": "151.21"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "In this bill, section 62Q.184 is referenced with respect to compliance for prior authorization requirements.",
      "modified": [
        "Ensures that new prior authorization rules comply with existing health care laws."
      ]
    },
    "citation": "62Q.184"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "The bill ensures compliance with section 62Q.1841 regarding step therapy protocols.",
      "modified": [
        "Aligns step therapy requirements with existing statutory protocols for consistent application."
      ]
    },
    "citation": "62Q.1841"
  }
]

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