MN HF3196

Establishes step therapy override procedures allowing health plan companies to approve restricted prescription drugs when enrollees or providers meet specific conditions.

Health plan companies must consider evidence-based clinical practice guidelines when establishing step therapy protocols and provide clinical review criteria upon written request.

Grants overrides when the required drug is contraindicated, causes adverse reactions, or reduces functional ability; when enrollee previously tried the drug without success; or when enrollee is currently benefiting from a different drug.

Requires health plan companies to respond to override requests within 5 days (72 hours for urgent cases) with specific reasons for denials; if no response sent within timeframe, the override is automatically granted.

Allows step therapy override requests to be submitted electronically by health care providers; denials are appealable and eligible for external review, and health plans may still require generic or biosimilar drugs first.