HF4142

Purpose

• To restrict coverage under medical assistance (MA) for prescription drugs that are used solely for weight loss.
• To require the creation of a formal drug formulary for MA and to set rules for how changes to the formulary are made and reported.
• To improve transparency and oversight by notifying affected patients and providers of changes and by requiring annual reporting on formulary effects.

Main Provisions

• Establishment of a drug formulary by the commissioner, with the Formulary Committee providing review and comments on its contents. The establishment/publication of the formulary is not subject to the Administrative Procedure Act, but the committee reviews it.
• The formulary must not include:
  • Drugs, active ingredients, or products lacking federal funding.
  • Over-the-counter drugs (except as provided elsewhere in the bill).
  • Drugs or active ingredients used for impotence or erectile dysfunction.
  • Drugs or ingredients when the medical value has not been established.
  • Drugs or active ingredients from manufacturers that have not signed a rebate agreement with the Department of Health and Human Services (DHHS) under section 1927 of title XIX of the Social Security Act.
  • Drugs or active ingredients used only for weight loss.
  • Medical cannabis flower or medical cannabinoid products as defined by the listed statutes.
• If a singlesource drug used by at least 2% of fee-for-service MA recipients is removed due to the manufacturer not signing a rebate agreement, the commissioner must notify prescribing practitioners within 30 days of CMS notification.
• The commissioner must provide written notice within 10 calendar days of any formulary change to all enrollees, prescribers, and pharmacists affected, including the description, reason, and effective date.
• Annual reporting (beginning January 15, 2026, and each year thereafter) on the effects of formulary changes to legislative chairs and ranking minority members. The report must cover:
  • How many times the formulary changed and why/how often.
  • Drugs removed and the number of enrollees who were prescribed each removed drug when it was removed.
  • Whether a therapeutically equivalent drug was added for each removed drug.
  • Drugs added to the formulary.
  • The fiscal impact on the Department of Human Services from the changes.
  • Enrollee populations or medical conditions disproportionately affected by the changes.

How this Changes Existing Law

• Adds a formal, structured drug formulary process to MA (256B.0625, subd. 13d) with explicit exclusions.
• Introduces specific restrictions on which drugs can be covered (notably weight-loss drugs, certain ED-related drugs, and cannabis/cannabinoid products, plus other categories).
• Imposes new notification requirements when formulary changes occur and annual public reporting to lawmakers.

Practical Implications

• Potential reduction in MA coverage for weight loss medications and certain other drug categories.
• Providers and patients will receive timely notices about formulary changes and must consider alternative therapies or therapeutically equivalent options when removals occur.
• Increased data collection and transparency about how formulary changes affect access and costs, with targeted attention to groups most impacted.

Timeline & Reporting

• Annual reporting requirement begins by January 15, 2026, and continues each year thereafter.

Important Definitions & Related Terms

• Drug formulary
• Minnesota Statutes 256B.0625 subdivision 13d
• Department of Health and Human Services (DHHS)
• Centers for Medicare and Medicaid Services (CMS)
• Rebates under section 1927 of title XIX of the Social Security Act
• Fee-for-service medical assistance recipients
• Enrollees, prescribers, and pharmacists
• Singlesource drug
• Over-the-counter drugs
• Erectile dysfunction (impotence)
• Medical cannabis flower and medical cannabinoid products
• Administrative Procedure Act (APA)
• Formulary Committee

Relevant Terms drug formulary; medical assistance; MA; Minnesota Statutes 256B.0625; subdivision 13d; CMS; Centers for Medicare and Medicaid Services; DHHS; rebate agreement; section 1927 of title XIX of the Social Security Act; fee-for-service; enrollees; prescribers; pharmacists; singlesource drug; weight loss drugs; over-the-counter drugs; erectile dysfunction; medical cannabis flower; medical cannabinoid products; Administrative Procedure Act; Formulary Committee; annual report; health and human services policy and finance committees; January 15, 2026.