Minn. Stat. § 62Q.83
This is the official text of Minn. Stat. § 62Q.83, part of Minnesota’s Stat — part of the compiled statutory law of Minnesota, published by the state as "Stat." Browse the sections below, each linked to its official government source.
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§ 62Q.83 FORMULARY CHANGES.
Official statutory text
§ Subdivision 1. Definitions. (a) For purposes of this section, the following terms have the meanings given. (b) "Drug" has the meaning given in section 151.01, subdivision 5 . (c) "Enrollee" has the meaning given in section 62Q.01, subdivision 2b . (d) "Formulary" means a current list of covered prescription drug products that is subject to periodic review and update. (e) "Health plan" has the meaning given in section 62Q.01, subdivision 3 . (f) "Pharmacy benefit manager" has the meaning given in section 62W.02, subdivision 15. (g) "Prescription" has the meaning given in section 151.01, subdivision 16a .
§ Subd. 2. Formulary changes. (a) Except as provided in paragraphs (b) and (c), a health plan must not, with respect to an enrollee who was previously prescribed the drug during the plan year, remove a drug from the health plan's formulary or place a drug in a benefit category that increases the enrollee's cost for the duration of the enrollee's plan year. (b) Paragraph (a) does not apply if a health plan changes the health plan's formulary: (1) for a drug that has been deemed unsafe by the United States Food and Drug Administration (FDA); (2) for a drug that has been withdrawn by the FDA or the drug manufacturer; or (3) when an independent source of research, clinical guidelines, or evidence-based standards has issued drug-specific warnings or recommended changes with respect to a drug's use for reasons related to previously unknown and imminent patient harm. (c) Paragraph (a) does not apply if a health plan removes a brand name drug from the health plan's formulary or places a brand name drug in a benefit category that increases the enrollee's cost if the health plan: (1) adds to the health plan's formulary a generic or multisource brand name drug rated as therapeutically equivalent according to the FDA Orange Book, a biologic drug rated as interchangeable according to the FDA Purple Book, or a biosimilar at the same or lower cost to the enrollee; and (2) provides at least a 60-day notice to prescribers, pharmacists, and affected enrollees.
§ Subd. 2. Formulary changes. (a) Except as provided in paragraphs (b) and (c), a health plan must not, with respect to an enrollee who was previously prescribed the drug during the plan year, remove a drug from the health plan's formulary or place a drug in a benefit category that increases the enrollee's cost for the duration of the enrollee's plan year. (b) Paragraph (a) does not apply if a health plan changes the health plan's formulary: (1) for a drug that has been deemed unsafe by the United States Food and Drug Administration (FDA); (2) for a drug that has been withdrawn by the FDA or the drug manufacturer; or (3) when an independent source of research, clinical guidelines, or evidence-based standards has issued drug-specific warnings or recommended changes with respect to a drug's use for reasons related to previously unknown and imminent patient harm. (c) Paragraph (a) does not apply if a health plan removes a brand name drug from the health plan's formulary or places a brand name drug in a benefit category that increases the enrollee's cost if the health plan: (1) adds to the health plan's formulary a generic or multisource brand name drug rated as therapeutically equivalent according to the FDA Orange Book, a biologic drug rated as interchangeable according to the FDA Purple Book, or a biosimilar at the same or lower cost to the enrollee; and (2) provides at least a 60-day notice to prescribers, pharmacists, and affected enrollees.
Status: in_force · Read it on the official government site
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