MN HF3031

Health carriers may not deny or limit coverage for services already received solely because prior authorization or second opinion was not obtained, if the service would otherwise be covered, effective January 1, 2021.

Group purchasers and pharmacy benefit managers must use a real-time prescription benefit tool complying with NCPDP standards to notify prescribers of drug coverage status, formulary inclusion, patient cost-sharing, prior authorization requirements, and alternative drugs without prior authorization requirements, effective January 1, 2021.

Health plan companies must make formularies and benefit information available electronically and in writing at least 30 days before annual renewal dates, organized consistent with United States Pharmacopeia Model Guidelines.

Health plan companies may only remove brand name drugs from formularies or increase enrollee costs if a generic, multisource, or interchangeable biologic drug is added at lower cost, with at least 60-day notice to prescribers, pharmacists, and enrollees.

Prescribers and dispensers must use NCPDP SCRIPT Standard for prescription communications and NCPDP Formulary and Benefits Standard for formulary information, with implementation according to Centers for Medicare and Medicaid Services schedules.