Bill Text: MI SB1002 | 2013-2014 | 97th Legislature | Introduced

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Bill Title: Insurance; third party administrators; pharmacy benefit managers; regulate practices of and place limits on health plans under contract with. Amends 1984 PA 218 (MCL 550.901 - 550.960) by adding secs. 25 & 26.

Spectrum: Partisan Bill (Republican 2-0)

Status: (Introduced - Dead) 2014-06-12 - Referred To Committee On Insurance [SB1002 Detail]

Download: Michigan-2013-SB1002-Introduced.html

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SENATE BILL No. 1002

 

 

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 sections 25 and 26.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 25. A pharmacy benefit manager shall have a contracted

 

pharmacy network sufficient to ensure access to covered

 

individuals.

 

     Sec. 26. (1) A pharmacy benefit manager shall not do any of

 

the following:

 

     (a) Mandate that a covered individual use a specific retail

 

pharmacy, mail-order pharmacy, specialty pharmacy, or other

 

pharmacy or entity if the PBM has an ownership interest in the

 

pharmacy, practice site, or entity, or the pharmacy, practice site,

 

or entity has ownership interest in the PBM.

 

     (b) Provide an incentive to a covered individual to encourage

 

the use of a specific pharmacy if that incentive is only applicable

 

to a PBM pharmacy.

 

     (c) Require that a pharmacist or retail pharmacy participate

 

in a network managed by the PBM as a condition for the retail

 

pharmacy to participate in another network managed by the same PBM.

 

     (d) Exclude an otherwise qualified pharmacist or retail

 

pharmacy from participation in a particular network if the

 

pharmacist or pharmacy accepts the terms, conditions, and

 

reimbursement rates of the PBM, meets all applicable federal and

 

state licensure and permit requirements, and has not been excluded

 

from participation in any federal or state program.

 

     (e) Automatically enroll or disenroll a retail pharmacy in a

 

contract or modify an existing agreement without written agreement

 

of the pharmacist or retail pharmacy.

 

     (f) Contract with a benefit plan to provide pharmacy benefit

 

manager services unless the benefit plan complies with both of the

 

following:

 

     (i) It permits covered individuals to receive prescription drug

 

benefits, which may include a 90-day supply of covered prescription

 

drugs, at any of the PBM's network retail pharmacies.

 

     (ii) It does not impose on a covered individual utilizing a

 

retail pharmacy a copayment, deductible, fee, limitation on

 

benefits, or other condition or requirement that is not otherwise

 

imposed on the covered individual when using a mail-order pharmacy.

 

     (2) Subsection (1)(f) does not prohibit a pharmacist who is

 

exercising his or her professional judgment from dispensing

 

additional quantities of medication up to the total number of

 

dosage units authorized by the prescriber on an original

 

prescription or on a refill.