The bill amends the Social Welfare Act to establish guidelines regarding the prior authorization process for prescription drugs under the medical assistance program in Michigan. It specifies that if the Department of Health and Human Services develops such a process, it cannot require prior authorization for certain categories of prescription drugs. These include specific central nervous system drugs, drugs cross-indicated for those, and medications recognized for treating conditions outlined in the latest diagnostic manual by the American Psychiatric Association, among others. Notably, the bill includes provisions for opioid withdrawal management and opioid use disorder treatments, specifically mentioning buprenorphine/naloxone tablets exceeding 32 milligrams.

Additionally, the bill clarifies that these provisions apply to drugs provided under contracts with health maintenance organizations and does not prevent the department from contracting with managed care organizations for pharmaceutical services, provided they comply with the new regulations. Definitions for terms such as "controlled substance," "cross-indicated," "prescriber," and "prior authorization" are also included to ensure clarity in the implementation of these guidelines.

Statutes affected:
Senate Introduced Bill: 400.109