MN SF2897

Establishes a step therapy override process allowing health plan companies to override drug sequencing protocols when specified medical conditions exist, effective January 1, 2019.

Requires health plans to grant overrides when the prescribed drug is contraindicated, causes documented adverse reactions, or decreases functional ability based on pharmaceutical labeling or documented medical conditions.

Permits overrides when an enrollee previously tried the required drug or a similar medication and experienced treatment failure or adverse events, unless clinical guidelines support trying another drug in the same class.

Mandates health plans respond to override requests within 5 days (or 72 hours in emergent cases), with automatic approval if no response is provided within the deadline; denials must specify why requirements were not met and inform of external review rights.

Requires step therapy override requests be submitted electronically through secure transmission by healthcare providers and accepted by group purchasers; permits health plans to request supporting medical documentation and require generic or biosimilar trials before branded drug coverage.