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Senate committee advances bill to limit mid-year formulary changes for patients on established medications
Summary
Senate File 1806 would restrict health plans from removing or changing coverage for medications that a patient is already taking mid-contract year; the committee adopted an author's amendment and recommended the bill for passage and referral to Health & Human Services with further fiscal review expected.
Senate File 1806, considered March 11 by the Minnesota Senate Committee on Commerce and Consumer Protection, would limit insurers and pharmacy benefit managers from forcing patients off medications that are working for them in the middle of a plan year.
Senator Mann, the bill sponsor, said the measure is intended to prevent interruptions to patients’ care when a formulary changes mid-year. ‘‘If a patient is on a medication, they can stay on that one medication until the end of the year,’’ Mann said, adding the bill is ‘‘not a formulary freeze’’ but a patient-protection measure.
Physicians and patient advocates testified in favor. Dr. Rolly Dwivedi, president of the Minnesota Academy of Family Physicians, described a patient whose diabetes control deteriorated after a mid-year formulary change and appealed coverage; the patient later experienced an emergency-room visit before the appeal was resolved. ‘‘For patients like Som, a formulary change is not just a policy update, it's a disruption that can mean the difference between stability and crisis,’’ Dr. Dwivedi said. Sue Abderholden, executive director of NAMI Minnesota, urged support and described the harms when psychiatric medications are changed without continuity of care.
Industry witnesses including Dan Andresen of the Minnesota Council of Health Plans and Joe Sellwood of the Association for Accessible Medicines outlined operational and market concerns. Andresen warned that taking away a plan's ability to manage formularies in response to manufacturer price shocks could increase premiums and that similar requirements should also apply to state public programs. Sellwood asked the committee to consider explicitly including biosimilars within exceptions to preserve access and competition.
Committee members raised additional questions about notice requirements for patients and whether the bill should define a minimum advance notice period so patients could arrange alternative care or plan changes; Senator Mann said current law does not require advance notice to patients. The committee adopted an author's amendment (A1 recorded in committee discussion) and by voice vote recommended Senate File 1806 to pass and be referred to the Committee on Health and Human Services; the committee noted fiscal notes were pending and expected to be transmitted to HHS for further review.
The bill's supporters framed it as protecting patients—particularly those with chronic conditions or mental illness—from abrupt medication changes that can require appeals, new prescriptions, or emergency care. Insurer and PBM witnesses said the underlying driver of formulary instability is drug pricing and rebates, and they urged the committee to consider manufacturer-side solutions as well.
