SF5142

Purpose

This bill would require health plan companies to cover dementia-related medical services and prescription medications that are approved by the U.S. Food and Drug Administration (FDA) and to cover diagnostic tests that help determine whether a dementia treatment is appropriate or effective. It also aims to modify step therapy requirements tied to Medical Assistance, making it easier for people with dementia to get needed treatments without unnecessary barriers.

Main Provisions

• Coverage for dementia treatments:
  • Health plan companies must provide coverage for every type of medical service and every FDA-approved prescription medication used to treat or slow the progression of dementia.
  • Health plan companies must also cover diagnostic testing to determine the appropriateness or effectiveness of a dementia treatment or service.
• Prohibition on step therapy:
  • Health plan companies are prohibited from using a step therapy protocol when providing the dementia coverage described above. Step therapy is a process that requires trying one or more treatments before approving another.

Relationship to Existing Law

• The bill would amend Minnesota Statutes 2024 section 256B.0625 subdivision 13f to reflect these dementia coverage requirements and related changes.
• It would also code the new requirements in Minnesota Statutes chapter 62Q (the section referenced is 62Q.546 for dementia coverage).

Practical Impact

• People with dementia would gain broader insurance coverage for both treatments and the tests used to guide treatment decisions.
• The use of step therapy for dementia treatments would be restricted or eliminated under this coverage, potentially reducing delays in accessing appropriate therapies.
• The bill affects Medical Assistance by modifying step therapy requirements related to dementia care.

Relevant Terms - dementia - FDA-approved - medical services - prescription medications - diagnostic testing - coverage - health plan company - step therapy protocol - Medical Assistance - Minnesota Statutes 256B.0625 subdivision 13f - Minnesota Statutes chapter 62Q - 62Q.546 - treatment or slow the progression of dementia - appropriateness or effectiveness of a dementia treatment