Bill Text: MI HB4074 | 2017-2018 | 99th Legislature | Introduced
Bill Title: Insurance; health insurers; abuse-deterrent opioid analgesic drug; require coverage. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406u.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2017-01-25 - Bill Electronically Reproduced 01/24/2017 [HB4074 Detail]
Download: Michigan-2017-HB4074-Introduced.html
HOUSE BILL No. 4074
January 24, 2017, Introduced by Rep. Kesto and referred to the Committee on Insurance.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 3406u.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3406u. (1) A health insurance policy delivered, issued
for delivery, or renewed in this state that provides pharmaceutical
coverage must provide coverage for at least 1 abuse-deterrent
opioid analgesic drug product per opioid analgesic ingredient.
(2) Cost sharing for brand-name abuse-deterrent opioid
analgesic drug products covered under this section must not exceed
the lowest cost-sharing level applied to brand-name prescription
drugs covered under the policy.
(3) Cost sharing for generic abuse-deterrent opioid analgesic
drug products covered under this section must not exceed the lowest
cost-sharing level applied to generic prescription drugs covered
under the policy.
(4) An insurer cannot achieve compliance with this section by
increasing patient cost sharing or by issuing disincentives for
prescribers.
(5) An insurer shall not require an insured or enrollee to
first use a non-abuse-deterrent opioid analgesic drug product
before providing coverage for an abuse-deterrent opioid analgesic
drug product.
(6) This section does not prohibit an insurer from applying
utilization review requirements, including prior authorization, to
abuse-deterrent opioid analgesic drug products if the utilization
review requirements are applied to all opioid analgesic drug
products with the same type of drug release, immediate or extended.
(7) As used in this section:
(a) "Abuse-deterrent opioid analgesic drug product" means a
brand-name or generic opioid analgesic drug product approved by the
United States Food and Drug Administration with abuse-deterrence
labeling claims indicating its abuse-deterrent properties are
expected to deter or reduce its abuse.
(b) "Cost sharing" means any coverage limit, copayment,
coinsurance, deductible, or other out-of-pocket expense
requirements.
(c) "Opioid analgesic drug product" means a drug product that
contains an opioid agonist and that is indicated by the United
States Food and Drug Administration for the treatment of pain,
whether in an immediate release or extended release formulation and
whether or not the drug product contains other drug substances.
(d) "Prescriber" means that term as defined in section 17708
of the public health code, 1978 PA 368, MCL 333.17708.
Enacting section 1. This amendatory act takes effect 90 days
after the date it is enacted into law.
