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Bill would bar midyear formulary drops for patients already on medications; committee adopts amendment and lays measure over
Summary
Senate File 1806 would prevent insurers and PBMs from removing a medication from a patient's formulary mid-contract year once the patient has started a treatment course; the committee adopted an A5 amendment requiring reporting and notice and laid the bill over for further consideration after testimony from pediatricians, NAMI and trade groups.
Senate File 1806 would prohibit plans or pharmacy benefit managers (PBMs) from removing coverage for a patient’s established medication during the plan contract year; patients who begin a treatment could continue that medication until the end of the plan year.
Sponsor Senator Mann said the bill is prompted by constituent incidents in which patients could not obtain chronic medications at the pharmacy when a formulary changed midyear. She described cases including emergency-room presentations and clinical deterioration when medication access was disrupted.
The committee adopted an A5 amendment that expands exceptions for therapeutically equivalent substitutions, clarifies communication requirements to patients when changes are made, and adds an annual reporting requirement on formulary changes and the number of people affected.
Testimony included pediatricians and representatives of NAMI Minnesota who described clinical harms when medications are switched abruptly; they argued that patients and prescribers may need months to find effective alternatives and that some changes can precipitate severe withdrawal or symptom recurrence. The Minnesota Medical Association and American Academy of Pediatrics were cited in support by testifiers.
Trade groups including the Association for Accessible Medicines and the Pharmaceutical Care Management Association (PCMA) testified with technical concerns: AAM asked that biosimilars be included in exceptions and suggested preferred formulary placement for lower-cost biosimilars; PCMA opposed the bill as drafted, citing the need to respond to drug shortages and price spikes and offering alternatives such as requiring manufacturers to freeze prices for a calendar year.
Committee members discussed scope and applicability across markets, including Medicaid and managed-care products; the sponsor said the bill would apply broadly, including Medical Assistance and MinnesotaCare. The committee laid SF1806 over for possible inclusion to permit further work and fiscal analysis.
Supporters framed the bill as a patient-protection measure to prevent “bait-and-switch” coverage changes midyear; opponents raised concerns about supply, drug-pricing dynamics and potential premium impacts.
