Michigan House Bill HB5339

Michigan 2023-2024 Regular Session

• Introduced: 11/14/23
• Refer: 11/14/23

Caption

Insurance: health insurers; coverage for step therapy; modify. Amends sec. 3406t of 1956 PA 218 (MCL 500.3406t).

Impact

The proposed legislation is expected to significantly impact existing laws concerning healthcare prescription management. By mandating synchronization, the bill aims to streamline the medication management process, potentially making it more convenient for patients who have multiple prescriptions. Importantly, insurers are instructed to apply a prorated daily cost-sharing rate for these synchronized drugs, which might ease financial constraints for patients managing long-term conditions. However, the bill also specifies that no prorated dispensing fees will be reimbursed, which might affect the financial arrangements for pharmacies.

Summary

House Bill 5339 aims to amend the 1956 Insurance Code of Michigan specifically focusing on the synchronization of prescription drugs for individuals dealing with chronic long-term care conditions. The bill requires insurers and health maintenance organizations to offer programs for synchronizing multiple maintenance prescription drugs for insured individuals, contingent upon agreement among the patient, their physician, and pharmacist that synchronization is in the patient's best interest. Compliance with a set of stipulated conditions is also necessary for the synchronization to be valid, including that the medications must be covered by the insurance policy and not involve specific controlled substances, among other criteria.

Contention

One notable point of contention within the discussions surrounding HB 5339 pertains to the step therapy protocols that could affect patients' access to certain medications. While the bill requires insurers to have clear processes for exceptions to these protocols, concerns have been raised regarding the potential impact on patient care. Critics argue that even with these guidelines, there could be instances where patients might encounter barriers to receiving timely access to their prescribed medications, particularly if those medications do not align with the typical step therapy processes established by insurers. The balance between operational efficiencies for insurers and patient access to necessary medications remains a pertinent discussion.