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HF 1076

Pharmacy benefit managers and health carriers required to include lower-cost drugs in their formularies, and formulary structure and formulary tiering for each health plan required to give preference to the drug with the lowest out-of-pocket cost to the patient.

2025-2026 Regular Session Introduced by Esther Agbaje and 4 co-sponsors

HF 1076 requires PBMs and health plans to prioritize lower-cost, patient OOP drugs in formularies and tiering to reduce out-of-pocket costs for enrollees.

Author added Agbaje
#drugsandmedicine #healthandhealthdepartment
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WeVote Research Nonpartisan
Bill Summary · HF 1076

Summary of HF 1076 (Minnesota, 2025-2026)

Purpose and Intent

HF 1076 seeks to reform how pharmacy benefit managers (PBMs) and health carriers (health insurers) structure formularies and pricing to prioritize lower-cost, patient-out-of-pocket (OOP) drugs. The bill requires health plans and PBMs to include lower-cost alternatives in their formularies and to implement formulary structures and tiering that favor the drug with the lowest OOP cost to the patient. The overarching aim is to reduce patient costs at the point of sale and promote the use of cost-effective medications.

Key Provisions and Changes

  • Formulary Content Requirements

    • Mandates inclusion of lower-cost drugs within formularies maintained by PBMs and health carriers.
    • Encourages or requires consideration of comparative drug prices and patient OOP costs when selecting formulary options.

  • Formulary Structure and Tiering

    • Requires formulary design and tier placement to prioritize drugs with the lowest patient OOP costs.
    • Likely imposes criteria or standards for tier placement decisions, though the exact metrics (e.g., copayment/coinsurance levels, annual or per-prescription caps) are not specified in the provided summary.

  • Transparency and Alignment

    • Implicitly aims to align PBM and health carrier practices to promote affordability for enrollees.
    • May involve reporting or disclosure requirements for formulary decisions to ensure patient-centered cost considerations.

Who Would Be Affected

  • Pharmacy Benefit Managers (PBMs)

    • PBMs that administer drug benefit programs for health plans would need to implement and adjust formulary design and tiering to meet the lower-cost emphasis.

  • Health Carriers / Health Insurance Plans

    • Health insurers offering Minnesota health plans would need to revise formularies and tier structures to comply with the lower-OOP-cost prioritization.

  • Patients / Enrollees

    • Individuals purchasing health coverage or prescriptions through plans affected by the bill could experience lower OOP costs for certain medications, particularly those with cheaper alternatives within the formulary.

Procedural and Timeline Aspects

  • Introduction and First Reading

    • Introduced and referred to Health Finance and Policy on February 17, 2025.
    • Bill authors include initial sponsor Agbaje, with subsequent additions of Reyer, Bahner, Norris.

  • Sponsors

    • Co-sponsors: Matt Norris, Kristin Bahner, Esther Agbaje, Steve Elkins, Liz Reyer.

  • Next Steps (typical legislative process)

    • After referral, the bill would proceed through committee reviews (likely including health finance policy and related committees) for hearings, potential amendments, and votes.
    • If advanced, it would move to further readings and, eventually, floor votes in the Minnesota House of Representatives, and then potentially to the Senate and a governor’s veto/approval process.

Notes and Considerations

  • The summary provided does not include specific dollar figures, phasing timelines, or detailed metrics for determining “lowest OOP cost” (e.g., whether savings are based on copay, coinsurance, or annual maximums).
  • The exact definitions of “lower-cost drugs,” how alternatives are identified, and any grandfathering or transition rules would be clarified in the bill’s text and any associated administrative rules.
  • The impact will depend on finalized language, enforcement mechanisms, and any phased rollout provisions.

If you’d like, I can incorporate the full text of HF 1076 (when available) to extract precise provisions, timelines, and numerical thresholds for a more granular analysis.

Compiled from official sources — confirm details with the bill’s official record.

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