Bill Text: MI SB1001 | 2013-2014 | 97th Legislature | Introduced

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Bill Title: Insurance; third party administrators; pharmacy benefit managers; require contracts to include certain maximum allowable cost provisions and other general amendments. Amends 1984 PA 218 (MCL 550.901 - 550.960) by adding sec. 27.

Spectrum: Partisan Bill (Republican 2-0)

Status: (Introduced - Dead) 2014-06-12 - Referred To Committee On Insurance [SB1001 Detail]

Download: Michigan-2013-SB1001-Introduced.html

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SENATE BILL No. 1001

 

 

June 12, 2014, Introduced by Senators SCHUITMAKER and CASWELL and referred to the Committee on Insurance.

 

 

 

     A bill to amend 1984 PA 218, entitled

 

"Third party administrator act,"

 

(MCL 550.901 to 550.960) by adding section 27.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 27. All of the following apply to a contract between a

 

pharmacy benefit manager and a pharmacy:

 

     (a) The PBM shall include in the contract a current list of

 

the sources used to determine MAC price. The PBM shall update the

 

MAC price information at least every 7 days and provide a means by

 

which the pharmacy may promptly review MAC price updates in a

 

format that is readily available and accessible.

 

     (b) The PBM shall maintain a procedure to eliminate products

 

from the list of drugs subject to MAC price in a timely manner in

 

order to remain consistent with pricing changes in the marketplace.

 

     (c) The PBM shall include in the contract a process to appeal,

 

investigate, and resolve disputes regarding MAC price, which

 

process must include all of the following:

 

     (i) A 21-day limit on the right to appeal following the initial

 

claim.

 

     (ii) A requirement that the appeal be investigated and resolved

 

within 21 days after the appeal.

 

     (iii) A telephone number at which the pharmacy may contact the

 

PBM to speak to an individual responsible for processing appeals.

 

     (iv) A requirement that the PBM provide a reason for any appeal

 

denial and the identification of the national drug code of a drug

 

that may be purchased by the pharmacy at a price at or below the

 

benchmark price as determined by the PBM.

 

     (v) A requirement that the PBM make an adjustment by a date no

 

later than 1 day after the date of determination. This subparagraph

 

does not prohibit a PBM from retroactively adjusting a claim for

 

the appealing pharmacy or for another similarly situated pharmacy.