The bill amends the Social Welfare Act to establish guidelines for the prior authorization process for prescription drugs under the medical assistance program in Michigan. It specifies that the Department of Health and Human Services cannot require prior authorization for certain categories of prescription drugs, including central nervous system medications classified as anticonvulsants, antidepressants, antipsychotics, and noncontrolled antianxiety drugs. Additionally, it includes provisions for drugs that are cross-indicated for these categories, as well as those recognized for treating conditions outlined in the latest diagnostic manual by the American Psychiatric Association, such as substance use disorder.

Furthermore, the bill explicitly states that prior authorization will not be required for prescription drugs used to prevent or treat HIV/AIDS, cancer, organ replacement therapy, epilepsy, seizure disorders, and opioid withdrawal symptom management or opioid use disorder. Notably, it clarifies that there will be no dosage maximum for medications prescribed for opioid-related conditions. The bill also allows for the department to contract with managed care organizations for pharmaceutical services, provided they comply with the new provisions.

Statutes affected:
Substitute (S-1): 400.109
Senate Introduced Bill: 400.109
As Passed by the Senate: 400.109