McCall Hamilton Advocacy and Public Affairs

Updates About Agency Policy Updates

New Consumer Protections and Licensing Rules for Pharmacy Benefit Managers

Update: Nov 22-Dec 15, 2023

Governor Whitmer and the Department of Insurance and Financial Services (DIFS) are introducing new licensing rules for pharmacy benefit managers (PBMs) to alleviate prescription drug costs for Michiganders. These changes, outlined on a newly launched DIFS website, stem from a set of prescription drug bills enacted last year. Governor Whitmer has stressed the importance of ensuring affordable access to necessary medications without forcing tough choices between health and other expenses.

Director Anita Fox highlighted the role of PBMs in managing drug benefits and the significance of DIFS’ licensing authority in safeguarding Michiganders from soaring drug expenses. The legislation, born from recommendations by the Prescription Drug Task Force, imposed crucial consumer safeguards, including oversight on PBM licenses, bans on “gag clauses” and “spread pricing,” and requirements for PBMs to furnish transparency reports to DIFS. These measures aim to provide clarity, reduce costs, and enhance access to crucial drug cost information for Michigan residents.

MDHHS Announces 2024 Changes to the Healthy Michigan Plan

Update: Nov 22-Dec 15, 2023

Beginning January 1st, 2024, MDHHS will be implementing changes to the Healthy Michigan Plan (HMP) that affect cost-sharing and healthy behaviors for beneficiaries.

Enrolled individuals will not face care disruptions or benefit reductions due to these updates. Alterations to the plan include revised copayment obligations for beneficiaries aged 21 and older, where copayments may now be required at the point of service instead of through the MI Health Account. Exceptions for copayments related to chronic conditions and exemptions for medically frail individuals will be discontinued.

While encouraging healthy behaviors remains a focus, requirements for annual Health Risk Assessments and specific activities via the MI Health Account will no longer be mandatory or incentivized. MDHHS plans to collaborate with Medicaid Health Plans to introduce financial incentives for enrollees displaying improved health outcomes, adopting healthy behaviors, or completing screenings or procedures that contribute to better health.

MDHHS and DIFS Issue COVID-19 Testing, Vaccine, and Treatment Update

Update: May 8-19, 2023

With the Public Health Emergency ending on May 11, 2023, MDHHS and DIFS issued guidance to the public about the future of COVID-19 tests, vaccines and treatments related to cost and accessibility in the state of Michigan.

Both departments reminded individuals that testing and vaccines continue to be available to the public at little to no cost.

For specific information on available testing, vaccines, treatments, and data, please see the following links:

MDHHS Update on End of PHE.

DIFS Update on End of PHE.