06/23/2016

New Michigan Universal PA Form

Effective July 1, 2016

If you are involved in submitting prior authorization requests for prescription drugs, this new Michigan law will impact your workflow.

Starting July 1, 2016, the use of a new standardized Prior Authorization Paper Request Form for Prescription Drugs will be required.  This law was enacted to streamline the prior authorization process by reducing the variety of prior authorization forms that need to be filled out. It is important to note that this law does NOT impact prior authorizations that are submitted through internet web portals or platforms, such as Cover My Meds. This law is described under Section 2212c of Public Act 218 of 1956 (MCL 500.2212c).

What is it?:

• A standardized paper PA form (FIS 2288)
  • A two-page document that needs to be filled out when submitting a prior authorization via paper form.
  • In addition to the two-page form, third party payors (including the University of Michigan Prescription Drug Plan) may also require additional pages that are specific to the drug for which the prior authorization is being submitted. Refer to the third-party payor website for drug-specific requirements.
  • This form will be electronically available and transmissible (e.g., available on third party payor websites and transmissible by fax or similar device).
  • This paper form does not apply if the insurer uses an internet-based methodology (i.e., electronically submitted PAs through Cover My Meds or similar platform).

Which patients does this impact?:

• This law impacts patients who have Michigan-based third party payor plans for their prescription drug coverage.
• As a Michigan state law, this does not impact patients on:
  • Medicare Part B and D plans
  • Federal Employee Health Programs
  • Other federally sponsored prescription drug coverage plans
  • Out of State-based third party payor plans

Link to the Michigan Prior Authorization Request Form:

• https://www.michigan.gov/documents/difs/FIS_2288_501398_7.pdf
• Additional information may be required depending on the insurer