The bill amends the Michigan Insurance Code of 1956, specifically section 3406t, to enhance the management of maintenance prescription drugs for insured individuals. It mandates that insurers providing health insurance policies with prescription drug coverage must implement a program to synchronize multiple maintenance prescription drugs for patients with chronic long-term care conditions, provided that the patient, their physician, and a pharmacist agree on the synchronization. The bill outlines specific requirements for the drugs involved, including coverage under the health insurance policy, non-control substance status (with exceptions for anti-epileptic drugs), and compliance with prior authorization requirements.

Additionally, the bill introduces provisions regarding step therapy protocols, requiring insurers and utilization review organizations to base these protocols on clinical practice guidelines developed by expert panels. It mandates transparency in the step therapy exception process, ensuring that healthcare providers can easily request exceptions and receive timely responses. The bill also requires annual reporting on step therapy exception requests, including the number of requests received, approved, and denied, along with the reasons for denials. Overall, the legislation aims to improve patient care by facilitating better access to necessary medications while ensuring that insurers adhere to established clinical guidelines.

Statutes affected:
House Introduced Bill: 500.3406