MN HF2482

Changes to prior authorization clinical criteria during a plan year cannot apply until the next plan year for enrollees who already received prior authorization under the previous criteria, with fee-for-service Medicaid/MinnesotaCare providers operating on a calendar year basis

Exceptions allowing mid-year criteria changes include: FDA safety warnings or product withdrawals, independent research recommending changes due to patient harm, and (effective January 1, 2026) changes based on "previously unknown and imminent patient harm"

Brand name drugs can be removed from formularies mid-year if a therapeutically equivalent generic, multisource brand, or interchangeable biologic is added at lower cost to the enrollee, with 60-day notice to prescribers, pharmacists, and affected enrollees

Removes section 62M.18 from the list of utilization review provisions that apply to the commissioner when delivering Medical Assistance and MinnesotaCare services, effective January 1, 2026