SENATE BILL NO. 552

A bill to amend 1956 PA 218, entitled

"The insurance code of 1956,"

(MCL 500.100 to 500.8302) by adding section 3406ll.

the people of the state of michigan enact:

Sec. 3406ll. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription drugs shall cover a drug that meets both of the following requirements:

(a) The drug is not an opioid analgesic.

(b) The drug is prescribed for the treatment or management of pain.

(2) The coverage required under subsection (1) must include drugs described in subsection (1) on the preferred drug list or plan formulary. An insurer described in subsection (1) shall include the drug for coverage as soon as practicable or before the expiration of 90 days, whichever occurs first, after the drug is approved by the United States Food and Drug Administration for use in the treatment or management of pain and is available for retail sale. This subsection does not prevent an insurer from performing a review under an established review process that the insurer utilizes for coverage or inclusion of other prescription drugs before including a drug described in subsection (1) on the health insurance policy's preferred drug list or plan formulary. The insurer shall not use a review process under this subsection to delay or block coverage of the drug under the health insurance policy or deny a covered individual further access to the drug under the health insurance policy.

(3) In establishing and maintaining a preferred drug list or plan formulary, an insurer described in subsection (1) shall ensure that a drug described in subsection (1) is not disadvantaged or discouraged with respect to coverage relative to any opioid analgesic or narcotic drug that may be prescribed for the treatment or management of pain and is included on the preferred drug list or plan formulary. For purposes of this subsection, impermissible disadvantaging or discouragement includes, but is not limited to, the following:

(a) Designating a drug described in subsection (1) as a nonpreferred drug if an opioid analgesic or narcotic drug is designated as a preferred drug.

(b) Subject to section 2212e, establishing utilization review measures including, but not limited to, prior authorization or step therapy requirements for a drug described in subsection (1) that are more restrictive or extensive than the least restrictive or extensive utilization controls established for an opioid analgesic or narcotic drug.

(4) This section does not prohibit an insurer, in establishing or maintaining a preferred drug list or plan formulary, from preferring drugs as follows:

(a) An opioid analgesic over another opioid analgesic.

(b) A drug described in subsection (1) over another drug that meets the requirements of subsection (1).