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Bill

SB 397

Human services: medical services; exemption of certain prescription drugs from the medical assistance prior authorization process; provide for. Amends sec. 109h of 1939 PA 280 (MCL 400.109h).

2025-2026 Regular Session Introduced by Kevin Hertel and 1 co-sponsor

SB 397 exempts select prescription drugs from Michigan Medicaid prior authorization requirements to accelerate patient access to needed medications.

referred to Committee on Insurance
#health:pharmaceuticals #humanservices:medicalservices #stateagencies(existing):healthandhumanservices
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Bill Summary · SB 397

Legislative bill overview

SB 397 amends Michigan's medical assistance program to exempt certain prescription drugs from the prior authorization requirement, allowing patients to fill prescriptions more quickly without advance approval from insurance plans. The bill targets specific medications where prior authorization delays create health risks or administrative burdens.

Why is this important

Prior authorization delays can prevent patients from accessing needed medications promptly, potentially worsening health outcomes for vulnerable populations relying on Medicaid. By streamlining access to certain drugs, the bill aims to reduce healthcare barriers while managing program costs through selective exemptions rather than blanket changes.

Potential points of contention

  • Lack of specificity: The bill's language doesn't clearly identify which drugs receive exemptions, making it difficult to assess the fiscal and health impacts before passage
  • Cost implications: Removing prior authorization requirements could increase pharmaceutical spending for the state Medicaid program, affecting budget allocations elsewhere
  • Insurance company concerns: Insurers argue prior authorization controls overutilization and manages costs; exemptions may limit their ability to prevent unnecessary prescriptions

Compiled from official sources — confirm details with the bill’s official record.

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