On October 29, Senator Curt VanderWall (R-Ludington) introduced legislation in the Michigan Senate that calls for revamping the state’s prior authorization and step therapy process to protect the health of patients. Senate Bill 612 introduces new transparency, fairness, and clinical validity requirements to the process, ensuring patients receive timely coverage decisions and the care, treatment, and medications they need, when they need them, as determined medically-necessary by their physician.
Specifically, SB 612 requires that:
- Insurance companies publish their prior authorization requirements on their website in detail and in easily understandable language
- Insurance companies give 60 days’ notice of new prior authorization requirements
- Prior authorization requirements be based on peer-reviewed clinical data and input from actively practicing physicians in each specialty
- Adverse determinations and decisions on appeals be made by a physician in the same specialty as the service being requested
- Medical directors of insurance companies be licensed to practice medicine
- Insurance companies publish approval and denial rates
- Urgent and non-urgent prior authorization requests be acted upon within 24 and 48 hours, respectively
- Physicians may override step therapy if the medication is likely to cause the patient an adverse reaction, is expected to be ineffective, or the patient has already tried it under another insurer
SB 612 has been referred to the Senate Committee on Health and Human Services, of which Senator VanderWall is chair. Please click here to contact your state legislators today to urge them to support SB 612.