The Michigan Department of Public Health (MDHHS) and Centers for Medicare & Medicaid Services (CMS) are soliciting comments on their respective proposals related to the MDHHS Medicaid Health Plan Common Formulary and the impact of prior authorization policies on patient access to laboratory testing. If you are interested in voicing your thoughts, the time to do so is now as the comment periods for each will be closing soon.
MDHHS Medicaid Health Plan Common Formulary – Comments Due by June 12
The Michigan Medicaid Health Plan Common Formulary applies to pharmacy claims paid by Medicaid Managed Care Organizations – it does not apply to claims paid through Fee-for-Service. Quarterly, MDHHS receives public comments on the drugs included or not included on the Common Formulary, new drug products, prior authorization criteria, step therapy criteria and other topics related to drug coverage under the Common Formulary. These comments are then reviewed by MDHHS and the Michigan Medicaid Health Plan Common Formulary Workgroup and they may make changes based on the input received. The next drug classes to be reviewed by the Workgroup include GI, P&T Miscellaneous, Diabetes and Endocrine & Metabolic.
Visit Michigan.gov/MCOpharmacy to view the current Michigan Medicaid Health Plan Common Formulary.
Please send your comments by June 12, 2026, to:
Grace Gere, Pharmacy Formulary Compliance Specialist
Bureau of Medicaid Care Management & Customer Service
Michigan Department of Health and Human Services
P.O. Box 30479
Lansing, Michigan 48909-7979
Telephone Number: 517-241-2060
Fax Number: 517-763-0167
E-mail Address: MDHHSCommonFormulary@michigan.gov
CMS Prior Authorization and Access to Laboratory Testing – Comments Due by June 15
Included in CMS’s broader proposed rule to modernize prior authorization for medications and medical services is a specific Request for Information (RFI) on laboratory testing. CMS is interested in reducing burdens in this area and is asking for feedback from those most affected by the barriers created by laboratory prior authorizations.
This is a critical opportunity for physicians, patients, caregivers, advocates, and others to speak out against harmful administrative barriers that delay or deny medically necessary care. CMS needs to hear about the real-world impacts of these policies, including treatment delays, coverage denials, repeated blood draws, and unnecessary stress.
Key talking points in support of patient-centered rules include:
- Stop Timing-Based Denials: Prevent insurers from denying a critical test merely because an authorization was still pending on the day the blood was drawn.
- Eliminate Repeat Blood Draws: Protect patients from being forced to undergo redundant, painful procedures when a valid specimen is already available.
- Fast-Track Cancer Care: Establish mandatory expedited review pathways for oncology and other time-sensitive diagnostic tests.
- Ban Financial Penalties: Ensure patients, doctors, and labs aren't hit with surprise bills due to insurance paperwork delays beyond their control.
For more details, you can read the HHS Fact Sheet on the Proposed Rule.
Click here to submit comments to CMS via Documents.gov by June 15.
If you have any questions, please feel free to contact Stacey Hettiger, MSMS Senior Director of Advocacy and Payor Relations at shettiger@msms.org.