Michigan House Bill HB4814

Michigan 2025-2026 Regular Session

• Introduced: 8/26/25
• Refer: 8/26/25

Caption

Insurance: health insurers; coverage for treatment of menopause and perimenopause symptoms and waiver of prior authorization for prescription drugs or treatments for menopause and perimenopause symptoms; require. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406zz.

Impact

A significant aspect of HB 4814 is its provision to eliminate prior authorization requirements for hormone replacement therapies and associated medications. This change aims to enhance access to healthcare for women experiencing menopause and perimenopause by simplifying the process of obtaining necessary treatments. By prohibiting insurers from imposing step therapy or fail-first protocols, the bill seeks to prevent delays in care, thus acknowledging the importance of timely medical intervention during this life stage. This is expected to increase the standardization of coverage across different insurers in Michigan, providing clarity and consistency for patients.

Summary

House Bill 4814 aims to amend the 1956 PA 218, known as the Insurance Code of Michigan, by introducing a new section (3406zz) that focuses on health insurance coverage for treatments related to menopause and perimenopause. The bill specifies that any health insurer delivering, issuing for delivery, or renewing a health insurance policy in Michigan must provide coverage for medically necessary care related to these conditions, including hormone replacement therapy as defined by FDA standards. This aligns with efforts to ensure that women facing menopause receive necessary medical support without the barriers often associated with insurance requirements.

Contention

While the bill is primarily focused on improving healthcare provisions for menopausal and perimenopausal women, it may encounter some contention among stakeholders in the healthcare and insurance industries. Insurers might express concerns over the impact on their costs and the potential increase in claim activities resulting from expanded coverage requirements. On the other hand, advocates for women's health are likely to support the bill, emphasizing the necessity for equitable access to treatments that directly affect a significant portion of the population. The debate may center around the balance between insurance company regulations and the rights of individuals to receive comprehensive healthcare services.