03/16/2022

Michigan Senate Bill 412 Open Access to Cancer Medication Signed into Law March 10th!

March 15, 2022, Governor Whitmer signed into law Senate Bill 412 which expands the availability of critical prescription drugs for Michigan cancer patients.

Open Access History

In 2004, Republican Senators Bev Hammerstrom and Tom George introduced and passed into law Public Act (PA) 248, which exempted (or ‘carved out’) five classes of drugs from prior authorization in Medicaid Fee-for-Service: cancer, epilepsy, HIV-AIDS, mental health, and organ replacement therapy. The new law ensured that patients suffering under one of the exempted disease states would have open access to the critical medications determined by their physicians as necessary for their treatment, by eliminating such barriers to care as long waiting periods created by prior authorization requirements or being forced to fail first on other medications due to “step therapy” requirements.

However, in 2015 the Michigan Department of Health and Human Services (DHHS) moved to a “common formulary” for the Medicaid HMOs. This move threatened the carve out protections for the five protected classes due to a loophole in PA 248 which only included Medicaid Fee-for-Service and NOT the Medicaid HMOs. Since the FY 15-16 budget, stakeholders in the Open Access coalition have fought to include boilerplate under Section 1875 to extend the protections of PA 248 to all patients with these conditions on Medicaid. Note: the boilerplate did not extend these protections to cancer.

To avoid an annual fight to include the boilerplate language in the budget each year and to provide more certainty to Medicaid beneficiaries, it was recognized by all supporters of this language that there was a need to close the loophole in the statute.

SB 412 Developments

After an unsuccessful attempt to pass legislation during the 2019-2020 session, largely as a result of the COVID-19 pandemic and the lack of legislative bandwidth, Senate Bill 412 was born. Introduced in 2021 (the start of the new legislative session) by Senator Curtis Hertel, this legislation codifies the expansion of the carve out for the “protected” drug classes to include Medicaid managed care and takes the language in the budget boilerplate further by including cancer drugs.

After years of steady advocacy, the legislation was signed into law on Thursday, March 10 as Public Act 19 of 2022.

We view this development as a major win for access in the state, ensuring the protections we have fought for on the regulatory side and in the budget process are enshrined in law. With the passage of this legislation, prior authorization and other utilization management requirements cannot be imposed on drugs in any of the five protected classes under both Medicaid fee-for-service and managed care.