Bill
HB 4684
Requires insurers to create and get approved a Pain Management Access Plan that expands nonopioid options and nonpharmacologic therapies, reducing opioid bias.
HB 4684 – Summary of Key Provisions and Impact
Overview
- What it does: Creates a new requirement in the Michigan Insurance Code (1956 PA 218) to ensure health insurers provide broader access to pain management options beyond opioids, by requiring a comprehensive Pain Management Access Plan. The plan must emphasize nonopioid medications and nonpharmacologic services as alternatives to opioid/narcotic prescriptions, and must be developed, filed for approval, and implemented by insurers in Michigan.
- Primary goal: Expand access to a broad spectrum of pain management options and reduce undue emphasis on opioid-based pain treatment.
Section 3406ww – Core Provisions
1) Plan development and scope
- Insurers delivering, issuing for delivery, or renewing health insurance policies in Michigan must develop a Pain Management Access Plan.
- The plan must ensure adequate coverage and access to a broad spectrum of pain management services, including:
- Nonopioid, nonnarcotic medications for pain management.
- Nonmedication pain management services (e.g., nonpharmacologic therapies).
- Alternatives to the prescribing of opioid or narcotic drugs.
- The plan must align with guidelines developed by the state department (department).
2) Department review and approval
- Insurers must file the Pain Management Access Plan with the department for approval.
- The department’s review will consider:
- The adequacy of access to a broad spectrum of pain management services under the plan.
- Whether insurer policies unduly favor prescribed opioids or limit consideration of other pain management options.
3) Provider education and public information
- Insurers must distribute educational materials to network providers about the Pain Management Access Plan.
- Insurers must post information about the plan on their publicly accessible website.
Implementation and Timeline Considerations
- The bill establishes a filing-and-approval process with the state department, but does not specify an explicit effective date. In practice:
- After enactment, insurers would need to develop the plan and submit it to the department for approval.
- The department would assess access adequacy and potential opioid-bias in coverage.
- Insurers would then disseminate education to network providers and publish plan information online, subject to the department’s timeline for approval.
Affected Parties
- Insurers that deliver, issue for delivery, or renew health insurance policies in Michigan.
- Network providers (education materials must be provided to them).
- Policyholders and patients seeking pain management options.
- Michigan Department (regulatory guidance via guidelines and plan approval).
Legislative Actions and Status
- Introduced: March 12, 2025; introduced by Rep. Mike McFall and co-sponsors.
- 2025-04-03: Read first time; referred to Public Education (initial procedural step).
- 2025-06-25/26: Bill electronically reproduced and introduced; referred to Committee on Insurance; first reading conducted.
- Related: Companion bills SB 865 and HB 3450.
Notes for Readers
- No specific dollar amounts or funding provisions are included in the text provided.
- The bill emphasizes process (plan development, department approval, provider education, and online posting) rather than creating new funding or mandates on specific services beyond requiring the plan and its components.
Compiled from official sources — confirm details with the bill’s official record.
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