We are extremely pleased to announce that the Michigan Legislature has passed HB 4935! This is a bill that we have been strongly supporting since its introduction in 2015. Not only did AIPM/SPPAN send numerous letters of support to at least three different legislative committees, but Katie Duensing, SPPAN’s Assistant Director for Legislative and Regulatory Affairs, participated in a Lobby Day (organized by the National Patient Advocate Foundation) in Lansing, MI last month at which she gave a legislative issue briefing on prior authorization and pharmacy benefit management and then met with legislative offices to educate them about the bill in order to secure their support.
HB 4935 is a rather large bill with a very straightforward purpose: to ensure patient needs are at the heart of policies governing health insurance in Michigan. The bill makes a variety of updates to Michigan’s health-related insurance laws. Some of these changes are minor, such as updates in outdated terminology. However, other provisions create real and vital improvements to patient care in the state, such as ensuring that insurance companies make coverage determinations in a timely manner.
Of particular note, passage of HB 4935:
- Ensures that patients don’t suffer and/or deteriorate without vital prescriptions while waiting for coverage determinations. This is accomplished by requiring insurers to make a coverage determination for prescription drugs, and notify the patient and the patient’s prescribing physician of the determination, within 72 hours after the insurer receives the request. On a request for an expedited review of coverage for prescription drugs based on emergency circumstances, this time frame is shortened to 24 hours.
- Ensures that a health care provider’s clinical judgement is not inappropriately influenced by insurers. Under this bill, insurers shall not use any financial incentive or making any payment to a health professional that acts as in inducement to deny, reduce, limit, or delay specific medically necessary and appropriate services.
- Ensures that patients have a voice. Health maintenance organizations must establish a Consumer Advisory Council that reports to the HMO’s governing body. The Consumer Advisory Council must include at least one enrollee, one family member or legal guardian of an enrollee, and one consumer advocate.
We are thrilled with the passage of HB 4935, and most importantly, for the improved health care that its passage will mean for the citizens of Michigan. To the Michigan Legislature, Governor, and to the many organizations and advocates involved in the passage of this bill—we thank you!