Bill Text: MI HB5943 | 2019-2020 | 100th Legislature | Introduced
Bill Title: Health: pharmaceuticals; health care false claim act; modify exemption from criminal liability to exclude manufacturers of prescription drugs from providing discounts under certain circumstances. Amends secs. 2 & 4e of 1984 PA 323 (MCL 752.1002 & 752.1004a).
Spectrum: Slight Partisan Bill (Republican 4-2)
Status: (Introduced - Dead) 2020-09-24 - Referred To Committee On Ways And Means [HB5943 Detail]
Download: Michigan-2019-HB5943-Introduced.html
HOUSE BILL NO. 5943
July 21, 2020, Introduced by Reps. Tyrone
Carter, Frederick, Vaupel, Wozniak, Yaroch and Liberati and referred to the
Committee on Health Policy.
A bill to amend 1984 PA 323, entitled
"The health care false claim act,"
by amending sections 2 and 4a (MCL 752.1002 and 752.1004a), section 4a as amended by 2016 PA 80.
the people of the state of michigan enact:
(a) "Claim" means
any attempt to cause a health care corporation or health care insurer to make
the payment of a health care benefit.
(b) "Deceptive"
means making a claim to a health care corporation or health care insurer which that contains a statement of fact or which fails to reveal
a material fact, which statement or failure leads the health care corporation
or health care insurer to believe the represented or suggested state of affair
to be other than it actually is.
(c) "False"
means wholly or partially untrue or deceptive.
(d) "Health care
benefit" means the right under a contract or a certificate or policy of
insurance to have a payment made by a health care corporation or health care
insurer for a specified health care service.
(e) "Health care
corporation" means a nonprofit dental care corporation incorporated under Act No. 125 of the Public Acts of
1963, being sections 550.351 to 550.373 of the Michigan Compiled Laws; 1963 PA 125, MCL 550.351 to 550.373; a
hospital service corporation, medical care corporation, or a consolidated
hospital service corporation and medical care corporation incorporated or
reincorporated under Act No. 350 of
the Public Acts of 1980, being sections 550.1101 to 550.1704 of the Michigan
Compiled Laws, or incorporated or consolidated under Act No. 108 or 109 of the
Public Acts of 1939; the nonprofit health care corporation reform act, 1980 PA 350, MCL
550.1101 to 550.1704; or a health maintenance organization
licensed under Act No. 368 of the Public Acts of
1978, being sections 333.1101 to 333.25211 of the Michigan Compiled Laws.chapter 35 of the insurance code of 1956, 1956 PA 218,
MCL 500.3501 to 500.3573.
(f) "Health care
insurer" means any insurance company authorized to provide health
insurance in this state or any legal entity which that is
self-insured and providing health care benefits to its employees.
(g) "Health facility
or agency" means a health facility or agency, as that term is defined in section 20106 of the public
health code, Act No. 368 of the Public Acts of
1978, being section 333.20106 of the Michigan Compiled Laws.1978 PA 368, MCL 333.20106.
(h) "Knowing"
and "knowingly" means that a person is in possession of facts under
which he or she is aware or should be aware of the nature of his or her conduct
and that his or her conduct is substantially certain to cause the payment of a
health care benefit. "Knowing" or "knowingly" does not
include conduct which that is an error or mistake unless the
person's course of conduct indicates a systematic or persistent tendency to cause
inaccuracies to be present.
(i) "Person"
means an individual, corporation, partnership, association, or any other legal
entity.
Sec. 4a. (1) Neither of the following violates section
4:
(a) A rebate, or discount, product voucher, or other reduction in a consumer's out-of-pocket
expenses, including a copayment or deductible, from a drug
manufacturer or from a
company that licenses or distributes the drugs of a drug manufacturer to a the consumer for the consumer's use of a
drug manufactured, or licensed, or distributed by the drug manufacturer
or company, but only if both of the following
are met:
(i) The rebate, discount, product
voucher, or other reduction is not for a drug that has a lower-cost generically equivalent drug product or
biosimilar drug product, that a contract, certificate, or policy issued by a
health care insurer or health care corporation covering the consumer provides
coverage for on a lower cost-sharing tier.
(ii) The rebate, discount, product
voucher, or other reduction is made available to all eligible individuals
regardless of how the drug is paid for when it is provided to the consumer.
(b) A monetary payment
from a drug manufacturer to a consumer, the consumer's health professional, or
a vendor that has a contract with the drug manufacturer, for a health care
service that the prescribing information of a qualified drug requires or recommends for initiating
drug therapy.
(2) This section does not
alter any copayment, deductible, coinsurance, or other cost-sharing
requirements under a contract, certificate, or policy issued by a health care
corporation or health care insurer.
(3) As used in this
section:
(a) "Consumer's
health professional" means a health professional who did not prescribe the
qualified drug or who
does not have a financial relationship to the health professional who
prescribed the qualified drug.
(b)
"Eligible individual" means an individual who is not otherwise prohibited
under state or federal law from receiving or using a rebate, discount, product
voucher, or other reduction in the individual's out-of-pocket expenses,
including a copayment or deductible.
(c)
(b) "Health care service" means any of the
following:
(i) Monitoring for bradycardia or atrioventricular conduction.
(ii) Monitoring blood
pressure.
(iii) An
electrocardiogram.
(iv) A cardiac
evaluation by a physician.
(v) A complete blood
count test.
(vi) A liver function
test.
(vii) An eye
examination for macular edema.
(viii) A pulmonary
function test, if clinically indicated.
(ix) A vaccination.
(x) An additional
service included in the prescribing information by the United States Food and
Drug Administration.
(d) (c) "Health professional" means an
individual who is licensed or otherwise authorized to engage in a health
profession under article 15 of the public health code, 1978 PA 368, MCL
333.16101 to 333.18838.
(e) (d) "Physician" means an individual
licensed or otherwise authorized to engage in the practice of medicine under part
170 of the public health code, 1978 PA 368, MCL 333.17001 to 333.17084, 333.17097, or to engage
in the practice of osteopathic medicine and surgery under part 175 of the
public health code, 1978 PA 368, MCL 333.17501 to 333.17556.
(e) "Qualified drug" means a drug that has a United
States Food and Drug Administration approved indication to treat multiple
sclerosis.
