Attention-Deficit/Hyperactivity Disorder Drug Coverage Flexibility during Shortage _____________________________________

STATE OF MICHIGAN DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES Bulletin 2024-11-INS In the matter of: Attention-Deficit/Hyperactivity Disorder Drug Coverage Flexibility during Shortage _____________________________________/ Issued and entered this 20th day of March 2024 by Anita G. Fox Director The Director of the Department of Insurance and Financial Services is aware of a widespread, ongoing shortage of attention-deficit/hyperactivity disorder (ADHD) drugs. The shortage is due to several factors including demand and production limitations. While some insurers have made cost sharing accommodations, all insurers providing prescription drug coverage in Michigan are urged to exercise flexibility with coverage and cost-sharing decisions for the duration of this shortage. Examples of the flexibility include, but are not limited to, the following: • Working with insureds and providers to authorize or cover alternative drugs when covered drugs are unavailable due to the shortage (for example, authorizing name brand drugs when generic drugs are unavailable). • Extending to insureds the same cost-share to alternative drugs as would have been extended to covered drugs that are unavailable due to the shortage. • Avoiding preventable delays in treatment when a covered drug is unavailable due to the shortage and an alternative drug is available (for example, modifying prior authorization requirements). • Taking all reasonable steps to proactively provide communications to insureds explaining the accommodations available to assist insureds impacted by the shortage. The Department will exempt insurers from administrative action for failing to strictly adhere to an applicable requirement under the Insurance Code to the extent the insurer is exercising the flexibility discussed in this bulletin to address the ADHD drug shortage. Any questions regarding this bulletin should be directed to: Department of Insurance and Financial Services Office of Insurance Rates and Forms DIFS-OIRF@michigan.gov 530 W. Allegan Street – 7th Floor P.O. Box 30220 Lansing, Michigan 48909-7720 Toll Free: (877) 999-6442 /s/ ____________________________ Anita G. Fox Director