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MN HF5469
Bill
Status
5/13/2024
Primary Sponsor
Steve Elkins
Click for details
AI Summary
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Pharmacy benefit managers and health carriers must include lower-cost equivalent generic drugs in formularies when they include brand name drugs, based on wholesale acquisition cost comparisons.
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If a generic drug is already in a formulary, the equivalent brand name drug must be included if it has a lower wholesale acquisition cost than the generic drug.
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Equivalent biosimilars must be included in formularies when brand name biologics are covered, and brand name biologics must be included when biosimilars are covered, following the same wholesale acquisition cost comparison rules.
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Newly FDA-approved generic drugs or biosimilars with lower wholesale acquisition costs than existing formulary options must be immediately made available on formularies.
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Pharmacy benefit managers and health carriers must structure formularies to give preference to drugs with the lowest out-of-pocket cost to patients and cannot impose prior authorization, step therapy requirements, or pharmacy restrictions on the lowest-cost drug options, effective January 1, 2025.
Legislative Description
Pharmacy benefit managers and health carriers required to include lower-cost drugs in their formularies, and formulary structure and formulary tiering for each health plan required to give preference to drug with lowest out-of-pocket cost to patient.
Last Action
Introduction and first reading, referred to Health Finance and Policy
5/13/2024