Bill Text: MI SB0150 | 2015-2016 | 98th Legislature | Engrossed
Bill Title: Insurance; health insurers; health plans that provide prescription drug coverage; clarify requirements for synchronizing multiple prescriptions and dispensing fees. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406t.
Spectrum: Moderate Partisan Bill (Republican 4-1)
Status: (Passed) 2016-03-16 - Assigned Pa 0038'16 With Immediate Effect [SB0150 Detail]
Download: Michigan-2015-SB0150-Engrossed.html
SB-0150, As Passed Senate, September 17, 2015
SUBSTITUTE FOR
SENATE BILL NO. 150
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 3406t.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3406t. (1) An insurer that delivers, issues for delivery,
or renews in this state an expense-incurred hospital, medical, or
surgical group or individual policy or certificate that provides
prescription drug coverage, or a health maintenance organization
that offers a group or individual contract that provides
prescription drug coverage, shall provide a program for
synchronizing multiple maintenance prescription drugs for an
insured or enrollee if both of the following are met:
(a) The insured or enrollee, the insured's or enrollee's
physician, and a pharmacist agree that synchronizing the insured's
or enrollee's multiple maintenance prescription drugs for the
treatment of a chronic long-term care condition is in the best
interests of the insured or enrollee for the management or
treatment of a chronic long-term care condition.
(b) The insured's or enrollee's multiple maintenance
prescription drugs meet all of the following requirements:
(i) Are covered by the policy, certificate, or contract
described in this section.
(ii) Are used for the management and treatment of a chronic
long-term care condition and have authorized refills that remain
available to the insured or enrollee.
(iii) Except as otherwise provided in this subparagraph, are
not controlled substances included in schedules 2 to 5 under
sections 7214, 7216, 7218, and 7220 of the public health code, 1978
PA 368, MCL 333.7214, 333.7216, 333.7218, and 333.7220. This
subparagraph does not apply to anti-epileptic prescription drugs.
(iv) Meet all prior authorization requirements specific to the
maintenance prescription drugs at the time of the request to
synchronize the insured's or enrollee's multiple maintenance
prescription drugs.
(v) Are of a formulation that can be effectively split over
required short fill periods to achieve synchronization.
(vi) Do not have quantity limits or dose optimization criteria
or requirements that will be violated when synchronizing the
insured's or enrollee's multiple maintenance prescription drugs.
(2) An insurer or health maintenance organization described in
subsection (1) shall apply a prorated daily cost-sharing rate for
maintenance prescription drugs that are dispensed by an in-network
pharmacy for the purpose of synchronizing the insured's or
enrollee's multiple maintenance prescription drugs.
(3) An insurer or health maintenance organization described in
subsection (1) shall not reimburse or pay any dispensing fee that
is prorated. The insurer or health maintenance organization shall
only pay or reimburse a dispensing fee that is based on each
maintenance prescription drug dispensed.
Enacting section 1. This amendatory act applies to policies,
certificates, and contracts delivered, executed, issued, amended,
adjusted, or renewed in this state, or outside of this state if
covering residents of this state, beginning 365 days after the date
this amendatory act is enacted into law.
