MI SB0987

Prescribers must obtain prior authorization from the Michigan Department of Health for non-preferred Medicaid drugs, but may request a 72-hour emergency supply if the department's physician cannot be reached within 72 hours (extended if blocked by legal holiday).

Non-preferred drugs must be authorized if the prescriber certifies that the drug is medically necessary for patient stabilization, that no preferred alternative offers comparable benefit, or that documented failures on earlier regimens warrant the non-preferred drug.

Board-certified specialists may obtain authorization for non-preferred drugs by certifying the drug follows licensed indications or accepted medical practice, treats a condition within their specialty, and no preferred drug offers comparable benefit.

Patients already stabilized on a medication before becoming Medicaid eligible may continue that medication without prior authorization if discontinuation would cause serious health consequences; controlled substances still require authorization but cannot be denied unless dosage is inconsistent with licensed indications or accepted medical practice.

The prior authorization requirement does not apply to drugs provided through health maintenance organization contracts with the department.