Bill
SB 973
Private health plans that already cover contraceptives must provide in-network, prescription-free coverage for OTC and emergency contraception at point-of-sale starting Jan 1, 2026
Status and key dates
- Bill number: SB 973 (Substitute S-3 as reported)
- Sponsor: Senator Mary Cavanagh
- Introduced: Jan 29, 2025 (committee materials also show earlier Senate activity on substitute S‑3)
- Effective / implementation timing in bill text: coverage requirement begins January 1, 2026
- Committee: Health Policy
- Current procedural status (per materials provided): placed on second reading
Purpose / intent
- To increase access to contraception by requiring health insurers that already cover contraceptives to provide point‑of‑sale coverage at in‑network pharmacies for over‑the‑counter (OTC) contraception and emergency contraception without requiring a prescription.
Major provisions
- Insurer coverage requirement (beginning Jan 1, 2026): An insurer that delivers, issues, or renews a Michigan health insurance policy that provides coverage for contraceptives must provide coverage at an in‑network pharmacy for OTC contraception and emergency contraception without a prescription.
- Scope: Applies to insurers only where the health plan already provides contraceptive coverage.
- Definitions:
- "Contraception" — a drug, device, or other product covered on the insurer’s formulary that is FDA‑approved to prevent pregnancy; explicitly includes hormonal drugs administered orally, transdermally, or intravaginally.
- "Emergency contraception" — an FDA‑approved drug to prevent pregnancy after unprotected intercourse or suspected contraceptive failure.
- Administrative limits: Required coverage is subject to the insurer’s existing utilization management, prior authorization, quantity limit, or precertification rules.
- Enforcement/penalties: Existing Insurance Code enforcement provisions (administrative hearings and civil fines) may apply for violations.
Who would be affected
- Insurers: Health plans issued, delivered, or renewed in Michigan that currently cover contraceptives will need to provide point‑of‑sale, in‑network coverage for OTC and emergency contraceptives without a prescription.
- Insured individuals: Plan members would be able to obtain OTC contraception and emergency contraception at in‑network pharmacies without a prescription—potentially reducing out‑of‑pocket costs and barriers to access.
- Pharmacies and pharmacy networks: In‑network pharmacies will be the point of dispensing for covered OTC contraceptives; pharmacy billing and reimbursement processes may require adjustments.
- Medicaid (related bill SB 974): SB 973 addresses private insurance; a companion Senate bill (SB 974) would require Medicaid to cover OTC contraception without a prescription. Analyses flag that the Medicaid change could have a significant and uncertain fiscal impact.
Fiscal impact
- Nonpartisan Senate staff analysis: SB 973 would have no direct fiscal impact on State or local government.
- House Fiscal Agency notes: enforcement fines under the Insurance Code are possible (civil fines up to specified statutory caps), which could produce general fund receipts if violations occur.
- Medicaid (SB 974): Separately, expanding Medicaid access to dispense preferred‑list contraceptives without prescriptions could carry a significant fiscal cost to the Department of Health and Human Services; scope and cost are uncertain.
Practical effects and considerations
- Increases direct, pharmacy‑based access to OTC contraceptives and emergency contraception for people covered by private plans that already include contraceptive benefits.
- Insurer utilization controls remain available, which could affect practical access (prior authorization, quantity limits).
- Coordination needed between insurers and pharmacy networks to implement point‑of‑sale reimbursement for OTC products.
- Separate legislative or administrative action (SB 974) would be needed to create equivalent prescription‑free access for Medicaid enrollees; that change raises fiscal and operational questions for the Medicaid program.
Compiled from official sources — confirm details with the bill’s official record.
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