MI SB0429

Commissioner must develop a standard prior authorization methodology for prescription drug benefits by January 1, 2013, including ability for prescribers to request expedited review.

Commissioner shall establish a workgroup within 30 days representing insurers, prescribers, pharmacists, hospitals, and other stakeholders to assist in developing the standard methodology, and hold public hearings for input.

If paper form is adopted, it must be no more than 2 pages (with exceptions for insurer-specified additional information), electronically available, and transmissible by facsimile or similar means.

Beginning January 1, 2014, prior authorization requests are deemed granted if insurers fail to approve, deny, or request additional information within 15 days for standard review or 72 hours for expedited review; requests become void if prescribers don't submit requested additional information within 21 days (standard) or 5 days (expedited).

Beginning July 1, 2014, insurers must use the standard methodology unless using an internet-based system that complies with subsections (4), (8), and (9).