1.1.................... moves to amend H.F. No. 3100, the fourth engrossment, as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. [16B.992] EMERGENCY INSULIN ASSISTANCE PROGRAM.
1.4    Subdivision 1. Establishment. The commissioner of administration shall implement
1.5and administer an emergency insulin assistance program beginning July 1, 2020, for insulin
1.6that is prescribed for self-administration on an outpatient basis.
1.7    Subd. 2. Contract with third-party administrator. The commissioner shall contract
1.8with a third-party administrator to provide assistance in administering the program. The
1.9initial negotiated contract is not subject to the requirements of section 16C.06. Any contract
1.10with a third-party administrator must:
1.11(1) require the third-party administrator to develop a program application form, process
1.12applications and insulin claims, and pay participating pharmacies at a rate at least as high
1.13as the medical assistance payment rate that would apply under section 256B.0625, subdivision
1.1413e, for insulin that is dispensed by the participating pharmacy to individuals under the
1.15program;
1.16(2) prohibit the use of rebates;
1.17(3) require the third-party administrator to consult with insulin manufacturers and develop
1.18standard application forms for the insulin manufacturer patient assistance programs required
1.19under section 151.24; and
1.20(4) state that the contract is subject to section 13.05, subdivision 11, and require that all
1.21data be maintained as private by the third-party administrator and not be shared with a third
1.22party without the patient's consent.
2.1    Subd. 3. Eligibility requirements. To be eligible for the program, an individual must
2.2have a valid prescription for insulin and attest to:
2.3(1) being a resident of Minnesota with a valid Minnesota identification card that indicates
2.4Minnesota residency including a drivers license, identification card, or permit if the individual
2.5is 18 years of age or older, or if the individual is under the age of 18, the individual's parent
2.6or legal guardian must meet this requirement;
2.7(2) having a family income that is equal to or less than 400 percent of the federal poverty
2.8guidelines;
2.9(3) not being enrolled in medical assistance or MinnesotaCare;
2.10(4) not being eligible to receive health care through the Indian Health Services, TriCare,
2.11or prescription drug benefits through the Department of Veterans Affairs;
2.12(5) not having access to prescription drug coverage through an individual or group health
2.13plan that limits the total amount of cost-sharing that an enrollee is required to pay for insulin,
2.14including co-payments, deductibles, or coinsurance to $100 or less for a 30-day supply of
2.15insulin;
2.16(6) not be receiving insulin through a manufacturer's patient assistance program; and
2.17(7) not having had insulin first dispensed through the program during the 12 months
2.18preceding the date of submission of the application.
2.19    Subd. 4. Application process. (a) The third-party administrator shall develop an
2.20application form to be used for this program. The application must:
2.21(1) require the applicant to indicate whether insulin is being requested on an emergency
2.22basis; and
2.23(2) provide for the applicant's consent to any transfer of personal data.
2.24The commissioner shall make the application form available on the agency website to
2.25pharmacies and to health care practitioners who are authorized to prescribe, administer, or
2.26dispense insulin.
2.27(b) An applicant must submit a signed and dated application form to the third-party
2.28administrator in order to obtain insulin under the program. By signing the application,
2.29applicants are attesting that the information contained in the application is correct and they
2.30need insulin on an emergency basis. An application for emergency insulin may be submitted
2.31through the agency website or as a paper application through a pharmacy. An individual is
2.32not eligible to reapply for the program until 12 months have elapsed from the date insulin
3.1was first dispensed to the individual under the program, at which time the individual must
3.2submit a new application form.
3.3(c) Upon receipt of a completed and signed application, the third-party administrator
3.4shall verify, if applicable, whether 12 months have elapsed from the date insulin was first
3.5dispensed under the program to the individual. The third-party administrator shall provide
3.6applicants satisfying this criterion and new applicants with an identification number,
3.7indicating that a completed application has been received. The information must be provided
3.8in a format that can be downloaded by the applicant or conveyed in an electronic format.
3.9(d) Any individual who submits a signed application containing any information that
3.10the individual knows is false or willfully misleading may be subject to section 256.98.
3.11    Subd. 5. Pharmacy participation. (a) Each pharmacy licensed under chapter 151 that
3.12dispenses insulin must participate in the program as a condition of doing business in this
3.13state.
3.14(b) A pharmacy shall dispense up to a one-month supply of insulin to individuals who
3.15present a valid prescription, completed application, and identification number, and who
3.16have indicated that they need insulin on an emergency basis. Upon dispensing insulin under
3.17the program, the pharmacy must submit a claim for reimbursement to the commissioner, in
3.18the form and manner specified by the commissioner.
3.19(c) A pharmacy must make program applications available at each pharmacy location
3.20and may assist applicants in applying for the program.
3.21(d) Eligible individuals are responsible for paying a co-payment to the participating
3.22pharmacy of $75 for the month's supply of insulin, or a proportional co-payment for quantities
3.23of insulin other than a month's supply, regardless of the amount or types of insulin needed.
3.24Insulin covered under the program for each individual is limited to a one-month supply.
3.25(e) When dispensing insulin to an eligible individual, a pharmacy must:
3.26(1) provide the individual with the address for the website established under section
3.27151.06, subdivision 6, paragraph (a); and
3.28(2) provide the individual with information about manufacturer assistance programs
3.29established under section 151.254.
3.30    Subd. 6. State and federal anti-kickback provisions. (a) The conduct of any person
3.31or entity in participating in or administering the emergency insulin assistance program under
3.32this section is not subject to liability under section 62J.23, subdivisions 1 and 2.
4.1(b) No person or entity, including but not limited to any drug manufacturer, pharmacy,
4.2pharmacist, or third-party administrator, as part of the person's or entity's participation in
4.3or administration of the emergency insulin assistance program established under this section,
4.4shall request or seek, or cause another to request or seek, any reimbursement or other
4.5compensation for which payment may be made in whole or in part under a federal health
4.6care program, as this term is defined in United States Code, title 42, section 1320a-7b(f).
4.7    Subd. 7. Report. By January 15, 2022, and by each January 15 thereafter, the
4.8commissioner, in consultation with the third-party administrator under contract, shall submit
4.9a report to the chairs and ranking minority members of the legislative committees with
4.10jurisdiction over health and human services policy and finance on the emergency insulin
4.11assistance program for the previous fiscal year, including:
4.12(1) the number of individuals who received insulin under the program;
4.13(2) the cost of the program, with a separate statement of administrative costs; and
4.14(3) the number of individuals who reapplied for the program.

4.15    Sec. 2. [62Q.678] DEPENDENT CHILD NOTICE.
4.16Group health plans and health plan companies that offer group or individual health plans
4.17with dependent coverage must provide written notice to an enrollee with dependent-child
4.18coverage and to the dependent child covered under the enrollee's plan that the dependent
4.19child's coverage ends when the child reaches the age of 26. Notice must be sent to both the
4.20enrollee at the enrollee's last known address and the dependent child at the dependent child's
4.21last known address at least 90 days before the dependent child reaches the age of 26. The
4.22notice must include the date on which coverage ends and information on accessing the
4.23MNsure website.

4.24    Sec. 3. Minnesota Statutes 2019 Supplement, section 151.06, subdivision 6, is amended
4.25to read:
4.26    Subd. 6. Information provision; sources of lower cost prescription drugs. (a) The
4.27board shall publish a page on its website that provides regularly updated information
4.28concerning:
4.29(1) patient assistance programs offered by drug manufacturers, including information
4.30on how to access the programs;
5.1(2) the emergency insulin assistance program established in section 16B.992 and the
5.2Minnesota insulin patient assistance program established in section 62V.12, including
5.3information on how to access each program;
5.4(3) the prescription drug assistance program established by the Minnesota Board of
5.5Aging under section 256.975, subdivision 9;
5.6(3) (4) the websites through which individuals can access information concerning
5.7eligibility for and enrollment in Medicare, medical assistance, MinnesotaCare, and other
5.8government-funded programs that help pay for the cost of health care;
5.9(4) (5) availability of providers that are authorized to participate under section 340b of
5.10the federal Public Health Services Act, United States Code, title 42, section 256b;
5.11(5) (6) having a discussion with the pharmacist or the consumer's health care provider
5.12about alternatives to a prescribed drug, including a lower cost or generic drug if the drug
5.13prescribed is too costly for the consumer; and
5.14(6) (7) any other resource that the board deems useful to individuals who are attempting
5.15to purchase prescription drugs at lower costs.
5.16(b) The board must prepare educational materials, including brochures and posters, based
5.17on the information it provides on its website under paragraph (a). The materials must be in
5.18a form that can be downloaded from the board's website and used for patient education by
5.19pharmacists and by health care practitioners who are licensed to prescribe. The board is not
5.20required to provide printed copies of these materials.
5.21(c) The board shall require pharmacists and pharmacies to make available to patients
5.22information on sources of lower cost prescription drugs, including information on the
5.23availability of the website established under paragraph (a).

5.24    Sec. 4. [151.254] REQUIREMENTS FOR INSULIN MANUFACTURER PATIENT
5.25ASSISTANCE PROGRAMS.
5.26    Subdivision 1. General requirement. Each manufacturer licensed under section 151.252
5.27that is engaged in the manufacturing of insulin prescribed for self-administration on an
5.28outpatient basis must operate an insulin access program and an insulin discount program
5.29that meets the requirements of this section, as a condition of doing business in this state.
5.30Each manufacturer must also cooperate with the third-party administrator under contract
5.31with the commissioner of administration to develop a standard application form for the
5.32programs required under this section.
6.1    Subd. 2. Insulin access program. (a) A manufacturer's insulin access program must
6.2determine eligibility using the standard application form developed by the third-party
6.3administrator under section 16B.992. The program must determine an applicant's eligibility
6.4within one-week of receipt of a completed application.
6.5(b) In order to be eligible for the program, a person must:
6.6(1) be a United States citizen or a legal noncitizen;
6.7(2) have a household income that does not exceed 400 percent of the federal poverty
6.8guidelines;
6.9(3) not be enrolled in medical assistance or MinnesotaCare;
6.10(4) not be eligible to receive insulin through Indian Health Services and not be enrolled
6.11in TRICARE or prescription drug benefits through the United States Department of Veterans
6.12Affairs;
6.13(5) not be enrolled in Medicare, unless: (i) the person has incurred annual out-of-pocket
6.14prescription drugs costs that exceed $1,000; or (ii) the person has applied for but denied a
6.15Medicare low-income subsidy; and
6.16(6) not have private insurance coverage for insulin.
6.17(c) The program must provide eligible persons with all medically necessary insulin for
6.18a 12-month period, without charge. Eligible persons may elect to have insulin shipped by
6.19the manufacturer to a designated physician or pharmacy, or directly to their residence.
6.20(d) The standards specified in this subdivision are minimum program standards. This
6.21subdivision shall not prohibit a manufacturer from operating a program with more expansive
6.22eligibility standards, or program features that provide additional value or access for eligible
6.23persons.
6.24    Subd. 3. Insulin discount program. (a) A manufacturer's insulin discount program
6.25must determine eligibility using the standard application form developed by the third-party
6.26administrator section 16B.992. The program must determine an applicant's eligibility within
6.27one-week of receipt of a completed application.
6.28(b) In order to be eligible for the program, a person must:
6.29(1) be a United States citizen or a legal noncitizen;
6.30(2) have a household income that does not exceed 400 percent of the federal poverty
6.31guidelines;
7.1(3) not be enrolled in medical assistance or MinnesotaCare;
7.2(4) not be eligible to receive insulin through Indian Health Services and not be enrolled
7.3in TRICARE or prescription drug benefits through the United States Department of Veterans
7.4Affairs; and
7.5(5) have private insurance coverage for insulin.
7.6(c) The program must reduce an individual's out-of-pocket cost to $99 or less for a
7.7month's supply of each insulin product.
7.8    Subd. 4. Applicant assistance. A manufacturer must operate a phone line to provide
7.9assistance to applicants, that is staffed 24-hours per day, seven days a week.
7.10    Subd. 5. Enforcement. (a) A manufacturer must provide the board of pharmacy with
7.11information necessary to verify compliance with this section, in the form and manner
7.12specified by the board.
7.13(b) The board may assess a manufacturer an administrative penalty of $1,000 per day
7.14for each violation of this section. This penalty shall not be considered a form of disciplinary
7.15action.
7.16(c) The board shall develop and implement a process that allows the public to file
7.17complaints against manufacturers for noncompliance.

7.18    Sec. 5. Minnesota Statutes 2019 Supplement, section 214.122, is amended to read:
7.19214.122 INFORMATION PROVISION; PHARMACEUTICAL ASSISTANCE
7.20PROGRAMS.
7.21(a) The Board of Medical Practice and the Board of Nursing shall at least annually inform
7.22licensees who are authorized to prescribe prescription drugs of the availability of the Board
7.23of Pharmacy's website that contains information on resources and programs to assist patients
7.24with the cost of prescription drugs. The boards shall provide licensees with the website
7.25address established by the Board of Pharmacy under section 151.06, subdivision 6, and the
7.26materials described under section 151.06, subdivision 6, paragraph (b). The boards shall
7.27also ensure that licensees are provided with information on the emergency insulin assistance
7.28program established under section 16B.992, including health care practitioners'
7.29responsibilities under the program and how patients can apply for the program.
7.30(b) Licensees must make available to patients information on sources of lower cost
7.31prescription drugs, including information on the availability of the website established by
7.32the Board of Pharmacy under section 151.06, subdivision 6.

8.1    Sec. 6. CITATION.
8.2This act may be cited as "The Alec Smith Insulin Affordability Act."

8.3    Sec. 7. EARLIER IMPLEMENTATION DATE FOR INSULIN ASSISTANCE
8.4PROGRAMS.
8.5(a) The governor may direct by executive order the commissioner of administration to
8.6begin operating the emergency insulin assistance program before the July 1, 2020,
8.7implementation date, and may direct by executive order the MNsure board to begin operating
8.8the Minnesota insulin patient assistance program before the July 1, 2020, implementation
8.9date. If the governor issues an executive order to begin the emergency insulin assistance
8.10program or the Minnesota insulin patient assistance program, or both programs, before July
8.111, 2020, an amount sufficient for this purpose is appropriated to the board of directors of
8.12MNsure, the commissioner of administration, and the commissioner of human services in
8.13fiscal year 2020, from the insulin assistance account.
8.14(b) If the governor does not issue executive orders under paragraph (a), the commissioner
8.15of administration shall implement the emergency insulin assistance program beginning July
8.161, 2020, as required under Minnesota Statutes, section 16B.992, and the MNsure board shall
8.17implement the Minnesota insulin patient assistance program beginning July 1, 2020, as
8.18required under Minnesota Statutes, section 62V.12.

8.19    Sec. 8. PUBLIC AWARENESS CAMPAIGN.
8.20The board of directors of MNsure, in consultation with the commissioner of
8.21administration, shall conduct a public awareness campaign to create awareness of the
8.22emergency insulin assistance program established under Minnesota Statutes, section 16B.992,
8.23and the Minnesota insulin patient assistance program established under Minnesota Statutes,
8.24section 62V.12. The campaign must focus on educating eligible individuals in need of
8.25assistance in purchasing insulin of the existence of the programs and on how to apply.

8.26    Sec. 9. APPROPRIATION.
8.27(a) $321,000 in fiscal year 2020 is appropriated from the health care access fund to the
8.28commissioner of administration to implement and administer the emergency insulin assistance
8.29program established under Minnesota Statutes, section 16B.992, including the cost of any
8.30contract with a third-party administrator. For fiscal years 2021 and beyond, an amount
8.31sufficient to fund the cost of reimbursing pharmacies for insulin dispensed through the
9.1program, and related administrative costs, is appropriated from the health care access fund
9.2to the commissioner of administration.
9.3(b) $250,000 in fiscal year 2020 is appropriated from the health care access fund to the
9.4board of directors of MNsure for a public awareness campaign for the emergency insulin
9.5assistance program established under Minnesota Statutes, section 16B.992. This is a onetime
9.6appropriation.
9.7(c) $250,000 in fiscal year 2020 and $250,000 in fiscal year 2021 are appropriated from
9.8the health care access fund to the board of directors of MNsure for MNsure navigator training
9.9and reimbursement related to the Minnesota insulin patient assistance program and the
9.10emergency insulin assistance program. This appropriation is added to the base.
9.11(d) In fiscal year 2020 and fiscal year 2021, an amount sufficient to reimburse the board
9.12of directors of MNsure for administrative costs related to the emergency insulin assistance
9.13program established under Minnesota Statutes, section 16B.992, is appropriated from the
9.14health care access fund to the board of directors of MNsure.
9.15EFFECTIVE DATE.This section is effective the day following final enactment."
9.16Amend the title accordingly