Prior Authorization Reform Legislation Passes in Michigan
April 6, 2022
Since early 2021, Michigan MS Activists – alongside a large group of coalition partners – have worked to reform the state’s prior authorization process, which is a large source of stress for individuals across the state living with multiple sclerosis. Prior authorization reform (SB 247) has officially passed both the Michigan State House and Senate and is now headed to the governor’s desk.
Prior authorization is a utilization management method used by insurance plans to control costs and review prescribed treatments. For many across the state, prior authorization has become a barrier to accessing MS disease-modifying therapies, MRIs, and more. The current processes have caused confusion for patients about what is covered, how long coverage lasts and how decisions on approvals are made. SB 247, filed at the start of 2021, will ensure transparency, fairness, and urgency for Michiganders requiring prior approval for their medications or a procedure.
Once SB 247 is signed into law by Governor Whitmer, it will enact a multitude of changes that will improve patient experience when accessing their medications and critical treatments. Changes included are the creation of a time limit on an insurer’s response to a request, a transition to an electronic form database, and criteria for doctors to follow when making appeals. Insurers will also be required to base decisions on scientific standards, or “peer reviewed” information.
For over a year, MS Activists have raised their voices and told their stories on this issue, completing action alerts and reaching out to their legislative officials. Accessing medications is one of the largest areas of frustration for individuals living with multiple sclerosis. MS Activists often fear their prior authorization will be denied at the beginning of each year, or even rescinded halfway through a calendar year. SB 247 is an important step towards fixing that issue.
Multiple sclerosis is an unpredictable disease of the central nervous system. Currently there is no cure. Symptoms vary from person to person and may include disabling fatigue, mobility challenges, cognitive changes, and vision issues. An estimated 1 million people live with MS in the United States. Early diagnosis and treatment are critical to minimize disability. Significant progress is being made to achieve a world free of MS.