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Committee advances bill to prevent mid‑year formulary demotions for patients already on medicines
Summary
House File 16 52 would bar health plans from removing or increasing enrollee cost-sharing for drugs already prescribed to that enrollee during the plan year. The committee adopted the A1 amendment, heard mixed testimony from physicians, patient advocates and industry groups, and laid the bill over for possible inclusion in the omnibus bill.
Representative Elkins presented House File 16 52 and the committee adopted the A1 author’s amendment shaping the bill’s scope. The legislation would prohibit a health plan from removing a drug from an enrollee’s formulary or moving it into a more costly benefit category for the remainder of the plan year if that enrollee had previously been prescribed the drug during that plan year.
Physician witnesses and patient advocates described clinical harms when a patient must switch medications mid‑year. Dr. Laurel Reese, a family physician testifying for the Minnesota Medical Association, said the bill focuses on continuity of care: "If they find that effective treatment plan, they will often choose their health insurance to continue the treatment that works...there's nothing in law that says that the insurance needs to continue the medication that they picked the plan for."
Mental‑health advocates echoed those concerns. Elliot Boutté of NAMI Minnesota said formulary changes can be disruptive and dangerous for people with serious mental illness, describing relapses and treatment interruptions when medication access changes mid‑year.
Industry witnesses warned of unintended consequences. Dan Andreesen of the Minnesota Council of Health Plans and Michelle Mack of the Pharmaceutical Care Management Association (PBM trade group) said manufacturers’ pricing and drug shortages sometimes force mid‑year formulary adjustments and that the bill could increase cost or administrative complexity. Andreesen told the committee such changes are rare in the fully insured market but acknowledged the self‑insured market differs.
Joe Selwood of the Association for Accessible Medicines urged adding an explicit exception for biosimilars, saying substitution rules should permit lower‑cost biosimilars where appropriate.
Committee members asked detailed questions about the bill’s mechanics, the department of human services and commerce department rate‑filing processes, and how plans currently protect prices after August rate filings. Representative Elkins said contracts and PBM agreements typically provide price protection across the plan year for existing drugs, and witnesses confirmed some form of protection exists.
The committee adopted the A1 amendment and laid House File 16 52 over for possible inclusion in the omnibus bill; no final legislative vote on enactment occurred in this hearing.
