2023 House Bill 5013

House Fiscal Agency Analysis

House Bill 5013 would amend the Insurance Code to require a health insurance policy delivered, issued for delivery, or renewed in Michigan that provides coverage for prescription contraceptives to include coverage for both of the following: • A 12-month supply of prescription contraceptives that are on the covered insured’s health plan formulary, furnished or dispensed, at a pharmacy in the insurer’s network, all at one time, unless the insured requests a smaller supply or the prescriber directs that the insured receive a smaller supply. • Outpatient consultations, examinations, procedures, and medical services that are necessary to prescribe, dispense, deliver, distribute, administer, or remove a prescription contraceptive, if those services are covered for other prescription drugs under the policy,. Prescription contraceptive would mean a drug, device, or other product, including a hormonal drug, whether administered orally, transdermally, or intravaginally, that requires a prescription and is approved by the United States Food and Drug Administration to prevent pregnancy. The required coverage would have to include furnishing or dispensing up to a 12-month supply of prescription contraceptives regardless of whether the insured was covered under the policy at the time the prescription contraceptive was first dispensed. However, an insurer would not be required to provide coverage for a 12-month supply in the one-month period before the end of an insured’s plan year. The coverage could be subject to provisions that apply equally to other prescription drugs covered by the policy, such required copayments, deductibles, and coinsurance. However, a policy described above could not be subject to utilization controls or other forms of medical management that limit the supply or coverage of a prescription contraceptive that may be dispensed or furnished by a prescriber or pharmacy to less than a 12-month supply unless the United States Food and Drug Administration determines that a 12-month supply is medically inappropriate. The bill would apply to health insurance policies delivered, executed, issued, amended, adjusted, or renewed in Michigan, or outside of Michigan if covering Michigan residents, beginning December 31, 2023.