MN Legislative Update: All-Payer Claims Database, Drug Formulary Changes + More

Minnesota Academy of Family Physicians (MAFP) lobbyist Dave Renner, CAE, shares an update from the Capitol, highlighting recent action on updating the All-Payer Claims Database (APCD), limits to drug formulary changes and the public option proposal and recapping the 2023 Physicians’ Day at the Capitol.

MAFP Priority: Update & Use APCD for Primary Care Study – Passes Second Committee

Legislation to update the All-Payer Claims Database (APCD) to collect more complete data on health care payments in Minnesota—HF 926 (Representative Elkins, DFL – Bloomington)—passed the Minnesota House Commerce Finance and Policy Committee on February 13, 2023, and was referred to the Judiciary Finance and Civil Law Committee.

Currently, the APCD, which is a health care analysis database used to study health care costs and outcomes, only collects payment data from insurance claims, excluding a large portion of payments—non-claims-based payments (e.g., value-based, infrastructure, care coordination and other patient support services).

Testifying in support of the bill, MAFP Legislative Committee Chair Nicole Chaisson, MD, MPH, told the committee, “We need to capture all the ways that we’re paying for health care to understand how to make our health care system work best for the people it serves and to ensure that we are getting value for our health care spending. Without this data, how do we—policy makers, health care team members and patients—set a vision for a system that works for Minnesotans?”

More and more payers are using value-based payments, which are not claims-based—therefore not collected in the APCD. HF 926 also directs the department to develop a report on the percentage of total payments that are non-claims based and the percentage of payments that are for primary care services.

“Family physicians, and other primary care providers, are critical as we embrace a value-based delivery and payment model that recognizes the importance of prevention, addressing health disparities and keeping people healthy,” said Chaisson.

Nicole Chaisson, MD, MPH, testifying before the House Commerce Finance and Policy Committee on February 13, 2023.

MAFP Priority: Limits on Drug Formulary Changes – Heard in House Committee

A second MAFP legislative priority also passed the Minnesota House Commerce Finance and Policy Committee on February 13, 2023. HF 294 (Representative Elkins, DFL-Bloomington) limits the ability of insurers and pharmacy benefit managers (PBMs) to force patients to change their medication during their enrollment contract year, even if the insurer or PBM changes their formulary because they received a better deal from the drug manufacturer. 

For many conditions, changing from one drug to another in the same class works fine for a patient. But for certain conditions, like mental illness, epilepsy, multiple sclerosis and others, changing medication mid-treatment can put a patient at risk for serious harm. 

“There is nothing more infuriating than when I have a patient stabilized on a medication that is working for her, and I hear the insurer or PBM changes its formulary, forcing my patient to change from the medication that is working,” said Chaisson, testifying on behalf of both the MAFP and the Minnesota Medical Association (MMA), “Why should an insurer or PBM be able to force my patient to change drugs when the PBM decides to no longer cover the drug that has been working? My patient cannot choose to go to another health plan until the end of his or her enrollment year.” 

HF 294 does not prohibit PBMs from changing formularies throughout the year. They can always add new drugs when they believe there is benefit as well as add a new generic when it becomes available. PBMs can also add new drugs that may be more cost-effective for a patient.  

The Senate companion, SF 328 (Senator Mann, DFL-Bloomington), is awaiting a hearing in the Senate Health and Human Services Committee.

MAFP Has Successful Physicians’ Day at the Capitol

NEW THIS YEAR: The MAFP hosted a lunch for family physicians, family medicine residents and medical students before meeting up with physician colleagues from other specialties for the MMA’s annual Physicians’ Day at the Capitol. Over 45 family physicians attended on February 8, 2023, joining more than 165 physicians, residents and medical students from across Minnesota.

MAFP member Senator Alice Mann, MD, MPH (DFL-Bloomington), spoke at the MAFP lunch, discussing why she chose to run for the Senate and encouraging all physicians to engage in advocacy. Members also heard from MAFP lobbyist Dave Renner, CAE, on priority issues for the MAFP.

Senator Kelly Morrison, MD (DFL-Deephaven), headlined the MMA’s Day at the Capitol program that afternoon, sharing about many of her legislative priorities, including protecting reproductive health, passing firearm safety reform, reducing the burden of prior authorization, among others. Following Senator Morrison’s talk, attendees proceeded to meetings with their individual House Representatives and Senators throughout the afternoon.

Public Option Proposal Receives Hearings in House and Senate

The Minnesota House Commerce Finance and Policy Committee heard HF 96 (Representative Long, DFL – Minneapolis), a bill that would allow more Minnesotans to purchase health coverage through MinnesotaCare. This is often referred to as a “public option.”

The bill would expand access to MinnesotaCare, the health care program for qualified, low-income Minnesotans. This is Minnesota’s Basic Health Plan that is subsidized with state and federal money.

The “public option” is proposed to offer affordable coverage to more Minnesotans. “This bill will lead to reductions in the uninsured, underinsurance and in uncompensated care,” the bill’s House author Representative Jamie Long (DFL – Minneapolis) said in a press event, “It’s time we finally provide affordable health care to all Minnesotans.”

Currently, MinnesotaCare is available to individuals and families who earn less than $27,000 for one person or less than $55,000 for a family of four. Under the proposal, beginning January 1, 2026, the program would be expanded to allow any Minnesotan to purchase coverage through MinnesotaCare, with a sliding scale premium based on their income.
The bill requires the Commissioner of Human Services to study and develop an implementation plan on the best way to administer a public option for health insurance and how to deliver cost-effective care for patients. Additionally, the bill would expand MinnesotaCare eligibility to undocumented Minnesotans who are currently barred from public care programs.
In the hearing, opponents outlined several concerns with the proposed reimbursement levels and sufficient provider participation. Government insurance programs offer low reimbursement rates for health care services. If the percentage of patients who are enrolled in a public program becomes too high, practices will not be able to continue to stay in business.

The committee passed the bill and referred it to the House Health Finance and Policy Committee where it will receive its next hearing. The bill’s companion, SF 49, was heard in the Senate Health and Human Services Committee on February 16, 2023, and laid over for further discussion.

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