Bill
HB 5013
Michigan insurers must allow a 12-month supply of prescription contraceptives in a single dispensing and cover related outpatient services with standard cost sharing.
Status and Sponsor
- Introduced by Rep. Julie M. Rogers (House Health Policy).
- Status (as of record you provided): Referred to Committee of the Whole.
- Applies to health insurance policies delivered, issued for delivery, amended, adjusted, or renewed in Michigan — and policies issued outside Michigan that cover Michigan residents.
Purpose / Intent
- To increase access to contraception by requiring insurers that already cover prescription contraceptives to allow the dispensing of up to a 12‑month supply at one time and to cover related outpatient services when those services are covered for other prescription drugs.
Key provisions
- Mandatory coverage: If a health plan provides coverage for prescription contraceptives, it must include:
- Furnishing or dispensing up to a 12‑month supply of a prescription contraceptive on the plan formulary, dispensed at an in‑network pharmacy in a single dispensing, unless the enrollee requests less or the prescriber directs a smaller supply.
- Outpatient consultations, examinations, procedures, and medical services necessary to prescribe, dispense, administer, deliver, distribute, or remove a prescription contraceptive — but only if such services are covered for other prescription drugs under the policy.
- Coverage for a prescriber‑determined medically necessary contraceptive.
- Cost sharing and parity: Coverage may be subject to the same cost‑sharing and terms (copayments, deductibles, coinsurance) that apply to other prescription drugs under the policy.
- Limits on utilization management: An insurer may not impose utilization controls or other medical‑management practices that limit dispensing to less than a 12‑month supply unless the U.S. Food and Drug Administration determines a 12‑month supply is medically inappropriate.
- Plan‑year exception: An insurer is not required to provide a 12‑month supply during the one‑month period before the end of an insured’s plan year.
- Definitions: “Prescription contraceptive” means an FDA‑approved prescription drug, device, or product (including hormonal methods administered orally, transdermally, or intravaginally) to prevent pregnancy. “Pharmacy” and “prescriber” reference Michigan public health code definitions.
Who is affected
- Insurers issuing health policies in Michigan (and out‑of‑state insurers covering Michigan residents).
- Covered individuals who receive prescription contraceptives (patients), prescribers, and network pharmacies.
- Administrators and payers of employer‑sponsored and individual health plans that currently cover contraceptives.
Timeline / Effective date
- The enacted/committee substitute version sets the effective date for application to policies beginning December 31, 2025 (various earlier drafts listed alternate timing; check the enrolled bill for final effective date).
Fiscal impact
- House/Senate fiscal analyses state the bill would have no fiscal impact on state or local government. No specific statewide cost estimate for private insurers is reported in these analyses.
Notes / Implementation
- The bill establishes insurance coverage obligations under the Michigan Insurance Code; enforcement would be through applicable state insurance regulatory mechanisms. The text does not specify an explicit private right of action or penalties beyond standard insurance regulatory authority.
Compiled from official sources — confirm details with the bill’s official record.
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