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 specific central nervous system medications, drugs cross-indicated for these medications, and those recognized for treating conditions outlined in the latest diagnostic manual by the American Psychiatric Association. Additionally, it includes provisions for drugs used in the treatment of cancer, organ replacement therapy, epilepsy, and opioid withdrawal or use disorder, explicitly stating that no dosage maximum will be imposed for opioid-related treatments.

The bill also 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, as long as they comply with the new regulations. Definitions for terms such as "controlled substance," "cross-indicated," and "prior authorization" are included to ensure clarity in the implementation of these guidelines.

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