Bill Text: MI SB1036 | 2019-2020 | 100th Legislature | Introduced
Bill Title: Human services: medical services; exemption of certain prescription drugs from the department of health and human services Medicaid prior authorization process; provide for. Amends sec. 109h of 1939 PA 280 (MCL 400.109h).
Spectrum: Partisan Bill (Democrat 10-0)
Status: (Introduced - Dead) 2020-07-23 - Referred To Committee On Health Policy And Human Services [SB1036 Detail]
Download: Michigan-2019-SB1036-Introduced.html
SENATE BILL NO. 1036
July 23, 2020, Introduced by Senators HERTEL,
HOLLIER, BRINKS, MCMORROW, CHANG, POLEHANKI, WOJNO, GEISS and BAYER and
referred to the Committee on Health Policy and Human Services.
A bill to amend 1939 PA 280, entitled
"The social welfare act,"
by amending section 109h (MCL 400.109h), as added by 2004 PA 248.
the people of the state of michigan enact:
Sec. 109h. (1) If the department of community health develops a prior authorization process for prescription drugs as part of the pharmaceutical services offered under the medical assistance program administered under this act, it the department shall not require prior authorization for the following single source brand name, generic equivalent of a multiple source brand name, or other prescription drugs:
(a) A central nervous system prescription drug that is classified as an anticonvulsant, antidepressant, antipsychotic, or a noncontrolled substance antianxiety drug in a generally accepted standard medical reference.
(b) A prescription drug that is cross-indicated for a central nervous system drug exempted under subdivision (a) as documented in a generally accepted standard medical reference.
(c) Unless the prescription drug is a controlled substance or the prescription drug is being prescribed to treat a condition that is excluded from coverage under this act, a prescription drug that is recognized in a generally accepted standard medical reference as effective in the treatment of conditions specified in the most recent diagnostic and statistical manual of mental disorders published by the American psychiatric association. Psychiatric Association, including substance use disorder. The department or the department's agent shall not deny a request for prior authorization of a controlled substance under this subdivision unless the department or the department's agent determines that the controlled substance or the dosage of the controlled substance being prescribed is not consistent with its licensed indications or with generally accepted medical practice as documented in a standard medical reference.
(d) A prescription drug that is recognized in a generally accepted standard medical reference to prevent acquisition of or to treat human immunodeficiency virus infection or complication of the human immunodeficiency virus or acquired immunodeficiency syndrome.
(e) (d) A prescription drug that is recognized in a generally accepted standard medical reference for the treatment of and is being prescribed to a patient for the treatment of any of the following:
(i) Human immunodeficiency virus infections or the complications of the human immunodeficiency virus or acquired immunodeficiency syndrome.
(i) (ii) Cancer.
(ii) (iii) Organ replacement
therapy.
(iii) (iv) Epilepsy or seizure disorder.
(2) This section does not apply applies to drugs being provided under a contract
between the department and a health maintenance organization.
(3) As used in this section:
(a) "Controlled substance" means that term as defined in section 7104 of the public health code, 1978 PA 368, MCL 333.7104.
(b) "Cross-indicated" means a drug which that is used for a purpose generally held to be reasonable, appropriate, and within community standards of practice even though the use is not included in the federal food and drug administration's United States Food and Drug Administration's approved labeled indications for that drug.
(c) "Department" means the department of community health and human services.
(d) "Prescriber" means that term as defined in section 17708 of the public health code, 1978 PA 368, MCL 333.17708.
(e) "Prescription" or "prescription drug" means that term as defined in section 17708 of the public health code, 1978 PA 368, MCL 333.17708.
(f) "Prior authorization" means a process implemented by the department of community health that conditions, delays, or denies the delivery of particular pharmaceutical services to medicaid beneficiaries medical assistance recipients upon application of predetermined criteria by the department or the department's agent for those pharmaceutical services covered by the department on a fee-for-service basis or pursuant according to a contract for those services. The process may require a prescriber to verify with the department or the department's agent that the proposed medical use of a prescription drug being prescribed for a patient meets the predetermined criteria for a prescription drug that is otherwise covered under this act or require a prescriber to obtain authorization from the department or the department's agent before prescribing or dispensing a prescription drug that is not included on a preferred drug list or that is subject to special access or reimbursement restrictions.
Enacting section 1. This amendatory act takes effect 90 days after the date it is enacted into law.
