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SB 978

Insurance: health insurers; coverage for emergency refill of prescription medication for up to a 30-day supply; repeal. Amends sec. 3406o of 1956 PA 218 (MCL 500.3406o) & repeals sec. 3406w of 1956 PA 218 (MCL 500.3406w).

2025-2026 Regular Session Introduced by Darrin Camilleri and 9 co-sponsors

SB 978 repeals emergency/early 30-day prescription refills and keeps formulary management with expedited and standard nonformulary exception timelines.

referred to Committee on Insurance
#health:pharmaceuticals #insurance:healthinsurers
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Bill Summary · SB 978

Summary of SB 978 (Michigan), 2025-2026 Session

Purpose and intent

  • SB 978 amends the Michigan Insurance Code (1956 PA 218) by repealing Section 3406w and modifying Section 3406o.
  • The core change is to remove a provision that allows health insurers to cover emergency or early refills of prescription medications for up to a 30-day supply. In effect, SB 978 repeals the emergency/early refill provision.
  • The bill is part of a broader package (SBs 973–979) regarding a proposed State-based Health Insurance Exchange (SBE); SB 978 itself focuses on Formulary-related requirements and repeals a specific coverage option for emergency refills. The supporting materials indicate broader reform goals (SBE and reinsurance), though SB 978’s standalone text centers on formulary provisions and the repeal.

Key provisions and changes

  • Amendments to Section 3406o (MCL 500.3406o):
    • Insurers that deliver, issue, or renew health insurance policies with prescription drug coverage that is formulary-restricted must:
    • Include physician, dentist, and pharmacist input in formulary development.
    • Disclose formulary restrictions to health care providers and, upon request, to insureds.
    • Provide for exceptions when a nonformulary alternative is medically necessary and appropriate, while allowing prior authorization or other processes for higher cost-sharing for nonformulary options.
    • Expedited review for nonformulary exceptions based on exigent circumstances must be completed within 24 hours after all necessary information is provided (enrollee/physician notified).
    • If expedited review (exigent circumstances) does not apply, the standard determination for nonformulary coverage must be made within 72 hours after all necessary information is provided.
  • Repeal of Section 3406w:
    • The temporary or specific authority that allowed emergency and early refills of prescription drugs (up to a 30-day supply under certain conditions) is repealed.
  • The remainder of 3406o’s provisions (about formulary management and exceptions) remain in place, subject to the repeal of 3406w.

Who is affected

  • Health insurers in Michigan that issue or renew health insurance policies with prescription drug coverage restricted by formulary.
  • Health care providers (physicians, dentists, pharmacists) who participate in formulary development and need to be aware of formulary restrictions and exceptions.
  • Enrollees/insured individuals who rely on formulary-based coverage and may request nonformulary alternatives or expedited consideration for coverage.
  • The repeal affects insurers who previously had the option to provide emergency/early refills under the repealed provision.

Procedural and timeline aspects

  • Effective date and specific effective timelines are not stated in the provided text; the bill would amend the Insurance Code upon enactment.
  • The changes introduce or reinforce expedited and standard timelines for coverage determinations on nonformulary exceptions:
    • Expedited exigent-conditions determinations: 24 hours after receipt of all necessary information.
    • Non-expedited determinations: 72 hours after receipt of all necessary information.
  • The repeal of 3406w eliminates the statutory allowance for emergency refills up to 30 days, reverting to standard formulary-based coverage rules unless otherwise governed by other sections of law.

Practical impact

  • Consumers with prescription drug coverage could experience changes in how emergency or early refills are handled, depending on remaining statutory or regulatory provisions and any related guidance.
  • Insurers must maintain formulary input processes and ensure timely communication of formulary restrictions and nonformulary exceptions.
  • Expedited review provisions for medical necessity and exigent circumstances may improve access to nonformulary options in urgent situations.

Note: The accompanying analysis indicates SB 978 is part of a broader package (SBs 973–978) proposing a statewide health insurance exchange and related reforms, but SB 978 itself centers on formulary management and the repeal of the emergency refill provision.

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

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