Bill
HB 4496
HB 4496 would require Michigan health insurance plans that cover prescription contraceptives to provide a single 12-month supply at one time, with standard cost-sharing.
Overview
- Purpose: Require health insurance policies in Michigan that cover prescription contraceptives to also provide a 12-month supply dispensed at one time, with related protections on access and cost-sharing.
- Bill number: HB 4496
- Sponsor (introduced): Rep. Julie Rogers (and co-sponsors); introduced May 15, 2025
- Status: Introduced and referred to Committee on Insurance (May 15, 2025). Earlier actions include filing on March 12, 2025 and first-time referral on April 3, 2025.
What the bill would require
- A health insurance policy delivered, issued for delivery, or renewed in Michigan that covers prescription contraceptives must include:
1) Coverage for a 12-month supply of prescription contraceptives (on the insurer’s formulary and dispensed at a network pharmacy) in a single dispensing, unless the insured requests a smaller supply or the prescriber instructs a smaller supply.
2) Coverage for any outpatient services that are necessary to prescribe, dispense, deliver, administer, or remove a prescription contraceptive (e.g., consultations, examinations, procedures), provided that the policy already covers those services for other prescription drugs.
- Coverage must apply even if the insured was not covered under the policy at the time the prescription was first dispensed.
- Cost-sharing (copayments, deductibles, coinsurance) may apply under the same terms as other prescription drugs, i.e., standard cost-sharing rules may apply to the 12-month supply.
- The bill prohibits utilization controls or other medical-management practices that would limit the 12-month supply or its coverage to less than a 12-month amount, unless the U.S. Food and Drug Administration determines that a 12-month supply is medically inappropriate.
- Notably, insurers are not required to provide a 12-month supply in the 1-month period immediately before the end of an insured’s plan year.
Definitions and scope
- “Pharmacy”: as defined in section 17707 of the Public Health Code.
- “Prescriber”: as defined in section 17708 of the Public Health Code.
- “Prescription contraceptive”: any FDA-approved drug, device, or other product (including hormonal options) that requires a prescription to prevent pregnancy.
Effective date and application
- Effective for policies delivered, issued, amended, adjusted, or renewed in Michigan, or outside Michigan if covering Michigan residents, beginning December 31, 2025.
- Applies to health insurers and policies within the stated scope.
Potential impact and considerations
- Access and adherence: A guaranteed 12-month supply could improve consistency of contraceptive use and reduce gaps in coverage.
- Cost implications: Insurers may face higher upfront dispensing costs and could adjust copays or deductibles in line with other drugs; long-term savings may arise from improved contraception adherence.
- Administrative considerations: Ensuring network pharmacies can dispense 12-month supplies and aligning with formulary and clinical guidelines.
- Limitations: The FDA’s determinations regarding 12-month supply appropriateness remain a controlling factor; near-term plan-year dynamics are addressed by the prohibition on 12-month purchases in the final month of a plan year.
In sum, HB 4496 seeks to standardize and expand access to long-term contraceptive coverage by mandating a 12-month supply option within Michigan health insurance policies, while preserving insurer cost-sharing structures and protecting against medically inappropriate restrictions.
Compiled from official sources — confirm details with the bill’s official record.
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