MN HF633

Health plan companies offering individual health plans must ensure at least 25 percent of plans in each geographic area and coverage level include a predeductible, flat-dollar co-payment structure for all prescription drug tiers.

Health plan companies offering small group health plans must ensure at least 25 percent of plans in each geographic area and coverage level include a predeductible, flat-dollar co-payment structure for all prescription drug tiers.

The highest allowable co-payment for the highest cost drug tier cannot exceed 1/12 of the plan's out-of-pocket maximum for an individual, and the co-payment tier structure must be graduated and proportionate.

Plans offered under this requirement must be clearly named, marketed the same as other health plans, and offered for purchase to any individual or small group, but the requirement does not apply to catastrophic plans, grandfathered plans, large group plans, HSAs, qualified high deductible plans, limited health benefit plans, or short-term limited-duration policies.

Health plan companies and pharmacy benefit managers cannot delay or divide pharmacy payments due to the co-payment structure, and companies must meet requirements separately for plans offered through MNsure and plans offered outside MNsure, effective January 1, 2024.