Purpose of the Bill

The bill is designed to update Minnesota's policies on drug prior authorization, specifically aiming to expand exceptions for mental health drugs. It seeks to streamline the process of getting certain medications for mental health conditions, improving access to necessary medications without unnecessary delays.

Main Provisions

• Prior Authorization Requirements: The bill outlines the circumstances under which drugs require prior authorization. This includes allowing the Formulary Committee to recommend and the commissioner to request prior authorization, especially for brand-name drugs with generic equivalents.

• Mental Health Drug Exceptions: The bill specifies that certain mental health medications (such as atypical antipsychotics and anticonvulsants), when prescribed for the treatment of mental illness, will not require prior authorization or other utilization management controls under specific conditions. This applies particularly if the medication was prescribed before a set date or is part of an ongoing treatment.

• Automatic Approvals: It requires that prior authorization is automatically granted for brand-name drugs within 60 days of a generic's availability if the brand-name drug was already part of the recipient’s treatment plan.

• Liquid Methadone and Oral Liquids: Prior authorization for liquid methadone is largely restricted, and automatic approval is set for oral liquid drugs prescribed for certain FDA-approved conditions, especially when administered through an enteral tube.

• New Drugs: The bill allows for automatic prior authorization for any new FDA-approved drugs for up to 180 days while the Formulary Committee determines the general criteria for continued authorization.

Significant Changes to Existing Law

• The bill expands the carve-out for mental health medications from prior authorization requirements.
• Establishes a protocol for automatic approvals under specific conditions, reducing barriers to accessing necessary medications for mental health and other critical conditions like HIV and AIDS.
• Introduces specific provisions to continue treatment without interruption when a drug becomes available in a generic form or is newly approved by the FDA.

Relevant Terms

• Prior Authorization
• Mental Health Drugs
• Atypical Antipsychotics
• Anticonvulsants
• Generic Drugs
• Enteral Tube Administration
• Liquid Methadone
• Step Therapy Protocols
• Food and Drug Administration (FDA)