Human services: medical services; requirement to prescribe generic medications; provide for. Amends 1939 PA 280 (MCL 400.1 - 400.119b) by adding sec. 109z.

2025-2026 Regular Session Introduced by Sarah Lightner

Medicaid would deny coverage for brand-name drugs when a generic exists unless the prescriber writes/initials DAW or explicitly instructs no substitution.

REFERRED TO COMMITTEE ON APPROPRIATIONS

#health:pharmaceuticals #humanservices:medicalservices

Purpose

HB 4839 would amend the Social Welfare Act (1939 PA 280) by adding section 109z to require the Michigan Department of Health and Human Services (the department) to deny medical-assistance (Medicaid) coverage for a brand‑name drug when an equivalent generic is available, unless the prescriber affirmatively documents that the brand is to be dispensed without substitution.

Key provisions

Adds section 109z to MCL 400.1–400.119b.

Prohibits department coverage for a brand‑name drug if an equivalent generic exists, except when a prescriber does one of the following:

For a written prescription signed by the prescriber: writes in the prescriber's own handwriting either “dispense as written” or “d.a.w.” on the prescription; or
For preprinted prescription blanks containing a substitution statement: the prescriber hand‑initials “d.a.w.” in the designated space/box adjacent to that statement; or
For prescriptions not in writing (e.g., verbal or other nonwritten communications): the prescriber expressly indicates the prescription is to be dispensed as communicated.

Defines terms used in the section, including “brand name,” “generic name,” “dispense,” “drug,” “prescriber,” and “prescription,” by reference to the Public Health Code (1978 PA 368).

Who is affected

Medicaid (medical assistance) program: coverage policy would be changed to favor generic substitution.

Prescribers: required to use specific, affirmative documentation to prevent substitution (handwritten “d.a.w.” or express indication).

Pharmacists: would be required to substitute generics where available unless valid prescriber DAW documentation exists.

Patients: increased likelihood of receiving generics; exceptions for clinical need require prescriber documentation.

Brand‑name drug manufacturers: potential reduced utilization within the Medicaid population.

Implementation and procedural notes

The provision instructs the department not to provide coverage for brand drugs when generics exist, rather than prescribing penalties—noncoverage is the enforcement mechanism.

The bill distinguishes written signed prescriptions from other forms; the handwritten/initial requirement may raise operational or interpretive questions for electronic prescribing systems or standing verbal orders (not explicitly addressed in the text).

Legislative history (selected):

Filed: 03/13/2025
Read first time: 04/03/2025
Committee hearings and substitute considered: April–May 2025; reported favorably as substituted 05/02/2025; committee report to Calendars 05/13/2025
Electronically reproduced and read again: 09/04/2025; subsequently referred to Appropriations.

Potential impacts to consider

Likely state Medicaid cost savings from increased generic use.

Possible administrative burden on prescribers and pharmacies to meet documentation requirements, and potential access issues for patients who require brand medicines for medical reasons if prescribers do not follow the specified documentation process.

Implementation questions regarding e-prescribing and what constitutes “written” or “expressly indicates” may require administrative guidance or regulatory clarification if enacted.

Bill