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HB 5435

Insurance: health insurers; coverage for pharmacist prescribing hormonal contraceptives; require. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406tt.

2023-2024 Regular Session Introduced by Julie Brixie and 13 co-sponsors

Insurers must cover pharmacist-prescribed hormonal contraceptives dispensed at in-network pharmacies, plus related consultations, once HB 5436 authorizes pharmacist prescribing.

assigned PA 241'24
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Bill Summary · HB 5435

Summary — HB 5435 (Public Act No. 241) — Pharmacist-prescribed hormonal contraceptive coverage

Status: Enacted as Public Act No. 241 (102nd Legislature). Approved by Governor; (Enrolled Act text indicates approval Jan. 21, 2025). Act effective date in enrolled text: April 2, 2025.
Note: The act does not take effect unless companion bill HB 5436 (pharmacist authority) is also enacted.

Purpose

To expand access to hormonal contraceptives by (1) authorizing pharmacists (via HB 5436) to prescribe and dispense certain contraceptives and (2) requiring health insurers to cover pharmacist‑prescribed hormonal contraceptives dispensed at in‑network pharmacies.

Key provisions — insurance (HB 5435 / Insurance Code amendment)

  • Adds MCL 500.3406tt to require that, in addition to any other legal coverage requirements, a health insurer that issues or renews a policy in Michigan which covers prescription drugs must also cover:
    • Hormonal contraceptive patch;
    • Self‑administered hormonal contraceptives (oral, injectable, etc.);
    • Vaginal ring hormonal contraceptives; — but only when those products are prescribed and dispensed by a pharmacist as authorized under the Public Health Code (see HB 5436).
  • Insurer must also cover consultation associated with the pharmacist prescription.
  • Coverage must be consistent with how the insured’s policy covers other prescription drugs.
  • Applicability: the amendment applies to policies delivered/issued/renewed in Michigan (or outside Michigan if covering Michigan residents) after December 31, 2025 (per enacting section).

Key provisions — pharmacist authority & practice (HB 5436, tied to HB 5435)

  • Authorizes pharmacists to issue prescriptions for:
    • Hormonal contraceptive patches, self‑administered hormonal contraceptives, vaginal ring contraceptives, and emergency contraceptives.
  • Definitions provided for these products (FDA‑approved drugs; self‑administered includes oral, injectable, etc.).
  • Rules and safeguards:
    • Department of Licensing and Regulatory Affairs (LARA), in consultation with the Michigan Board of Pharmacy, must promulgate implementing rules within 18 months of the bill’s effective date.
    • LARA/Board must develop a self‑screening risk assessment tool that individuals must complete before a pharmacist may issue a contraceptive prescription.
    • Pharmacists must complete Board‑approved training to prescribe under this authority.
    • Pharmacists must provide written record/receipt naming the prescribing pharmacist, refer patients to their primary care provider (or other licensed provider) and, in certain circumstances, advise or refer for physical exam.
    • Pharmacists must dispense as soon as practicable or transmit the prescription per rules.
  • The Public Health Code is amended to treat a pharmacist’s order under these provisions as a “prescription” for applicable purposes.

Who is affected

  • Insurers and health plans issuing Michigan policies (must cover pharmacist‑prescribed hormonal contraceptives starting for policies renewed/issued after 12/31/2025).
  • Pharmacists and pharmacies: new authority and regulatory obligations (training, use of screening tool, referral duties, documentation).
  • Patients/consumers: increased access to prescribed hormonal contraceptives at pharmacies; must complete self‑screening.
  • LARA and Michigan Board of Pharmacy: rulemaking and oversight responsibilities.

Implementation timeline & procedural notes

  • The act is tied to enactment of HB 5436 — both bills must be enacted for coverage requirement to take effect.
  • LARA must issue implementing rules within 18 months of the bill’s effective date.
  • Insurance coverage provision applies to policies delivered/issued/renewed after December 31, 2025 (per the enrolled act’s enacting section).

Fiscal impact

  • Nonpartisan analyses estimated a minimal fiscal impact: small additional administrative costs to LARA for rulemaking; no significant impact on local government. Insurer/plan cost impacts were not quantified in the committee analyses.

Limitations / other notes

  • Emergency contraceptives are included in pharmacist prescribing authority but HB 5435’s coverage requirement specifically lists hormonal contraceptives (patch, self‑administered, ring); emergency contraceptives are not explicitly required to be covered under HB 5435’s insurance provision.
  • Specific billing/payment mechanics for pharmacist services were discussed in earlier analyses but are not detailed in the final Insurance Code text added by HB 5435.

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

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