SF1739

This bill proposes the establishment of a Prior Authorization Commission within the Minnesota Department of Health to review medications with high prior authorization denial rates and recommend certain medications for exemption from prior authorization requirements.

Key Provisions:

1. Prohibiting Prior Authorization for Certain Services
   The bill amends Minnesota Statutes 62M.07 to prohibit prior authorization for:
   • Emergency confinements and emergency services.
   • Outpatient mental health and substance use disorder treatments (excluding medications).
   • Antineoplastic (cancer) treatments aligned with National Comprehensive Cancer Network guidelines (excluding medications).
   • Preventive services with A or B ratings from the U.S. Preventive Services Task Force, certain immunizations, and women’s preventive healthcare.
   • Pediatric hospice and neonatal abstinence program treatments.
   • Medications approved by the commissioner of health for exemption from prior authorization.

(Provisions 2-6 will take effect on January 1, 2026, applying to new and renewed health plans.)

1. Creation of a Prior Authorization Commission

   • The commission will review the 25 medications with the highest denial rates in Minnesota each year.
   • It will recommend medications for exemption based on criteria such as cost, utilization, effectiveness, coverage by health plans, and potential impact on premiums.
   • The nine-member commission includes representatives from:
     • The Department of Health (2)
     • The Department of Commerce (2)
     • The Minnesota Prescription Drug Affordability Board (2)
     • The Minnesota Medical Association (1)
     • Health plans offering drug benefits (1)
     • Pharmacy benefit managers (1)

2. Commissioner of Health's Role

   • By August 1, 2027, and annually thereafter, the commissioner of health must approve one medication for prior authorization exemption, selecting from the commission’s recommendations.
   • The commissioner must submit an annual report on the commission’s findings and recommendations to legislative committees overseeing health and commerce.

3. Health and Commerce Data Sharing

   • The Department of Human Services and the Department of Commerce may share data on drug benefits and utilization with the commission for its review, but the data must be used only for making recommendations.

Purpose:

This bill aims to streamline access to necessary medications, reduce delays caused by prior authorization, and enhance transparency in approval processes.