Updates About Agency Policy Updates

The United States Supreme Court’s recent decision to overturn the Chevron doctrine marks a significant shift in federal agency authority, impacting how regulations are interpreted and enforced across various sectors, including health care, environmental protection, and more. For decades, under Chevron, courts deferred to agencies’ interpretations of ambiguous statutes, but now, judges will hold greater discretion in evaluating these interpretations themselves. The 6-3 ruling, led by Chief Justice John Roberts, emphasized that agencies do not possess unique expertise in resolving statutory gray areas and that courts must now independently scrutinize agency interpretations instead of deferring to them automatically.

The ruling has polarized opinions, with conservatives applauding it as a check on executive overreach and liberals warning of potential chaos and setbacks in regulatory protections. This decision is expected to lead to increased legal challenges to federal regulations and could reshape how future administrations navigate policy implementation amid judicial scrutiny. It also raises questions about the future of major policy initiatives as administrations navigate a landscape where judicial decisions play an increased role in shaping regulatory outcomes.

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.

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.