Bill Text: MI SB0156 | 2021-2022 | 101st Legislature | Introduced
Bill Title: Insurance: health insurers; coverage for emergency refill of prescription medication of insulin for up to a 30-day supply; provide for. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406v. TIE BAR WITH: SB 0155'21
Spectrum: Partisan Bill (Republican 6-0)
Status: (Passed) 2021-07-15 - Assigned Pa 0037'21 With Immediate Effect [SB0156 Detail]
Download: Michigan-2021-SB0156-Introduced.html
SENATE BILL NO. 156
February 18, 2021, Introduced by Senators
DALEY, LAUWERS, NESBITT, THEIS, HORN and BIZON and referred to the
Committee on Health Policy and Human Services.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending section 3406o (MCL 500.3406o), as amended by 2016 PA 276, and by adding section 3406v.
the people of the state of michigan enact:
Sec. 3406o. (1)
An insurer that delivers, issues for delivery, or renews in this state a health
insurance policy that provides coverage for prescription drugs and limits those
benefits to drugs included in a formulary shall do all of the following:
(a) Provide for participation of participating physicians,
dentists, and pharmacists in the development of the formulary.
(b) Disclose to health care providers and upon request to
insureds the nature of the formulary restrictions.
(c) Provide for exceptions from the formulary limitation when
a nonformulary alternative is a medically necessary and appropriate
alternative. This subdivision does not prevent an insurer from establishing
prior authorization requirements or another process for consideration of
coverage or higher cost-sharing for nonformulary alternatives.
(2) On a request for an expedited review of coverage for a
nonformulary alternative based on exigent circumstances, an insurer shall make
a determination and notify the enrollee or the enrollee's designee and the
prescribing physician, or other prescriber, as appropriate, of the determination
within 24 hours after the insurer receives all information necessary to
determine whether the exception should be granted. For purposes of this
subsection, exigent circumstances exist when an enrollee is suffering from a
health condition that may seriously jeopardize the enrollee's life, health, or
ability to regain maximum function or when an enrollee is undergoing a current
course of treatment using a nonformulary drug.
(3) If subsection (2) does not apply, an insurer shall make a
determination on coverage for a nonformulary alternative and notify the
enrollee or the enrollee's designee and the prescribing physician, or other
prescriber, as appropriate, of the determination within 72 hours after the
insurer receives all information necessary to determine whether the exception
should be granted.
(4) This section is subject to section 3406v.
Sec. 3406v. Beginning on the effective date of the amendatory act
that added this section, an insurer that delivers, issues for delivery, or
renews in this state a health insurance policy that provides coverage for
prescription drugs shall provide coverage for an emergency supply of insulin
that is covered under an insured's health insurance policy and that is
dispensed to the insured by a pharmacist as provided in section 17744f of the
public health code, 1978 PA 368, MCL 333.17744f.
Enacting section 1. This amendatory act does not take effect unless Senate Bill No. 155 of the 101st Legislature is enacted into law.
