Bill Text: MI HB5598 | 2015-2016 | 98th Legislature | Introduced

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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 5-0)

Status: (Introduced - Dead) 2016-04-27 - Bill Electronically Reproduced 04/26/2016 [HB5598 Detail]

Download: Michigan-2015-HB5598-Introduced.html

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HOUSE BILL No. 5598

April 26, 2016, Introduced by Reps. Kesto, Crawford, Forlini, Lucido and Hughes 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) An expense-incurred hospital, medical, or

 

surgical policy or certificate delivered, issued for delivery, or

 

renewed in this state that provides pharmaceutical coverage and a

 

health maintenance organization contract that provides

 

pharmaceutical coverage shall 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 or contract.

 

     (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 or contract.

 

     (4) An insurer or health maintenance organization cannot

 

achieve compliance with this section by increasing patient cost

 

sharing or by issuing disincentives for prescribers.

 

     (5) An insurer or health maintenance organization 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 or health

 

maintenance organization 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.