***** 550.811.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.811.new Short title. Sec. 1. This act may be cited as the “pharmacy benefit manager licensure and regulation act”. History: 2022, Act 11, Eff. Jan. 1, 2024
***** 550.815.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.815.new Definitions; A to I. Sec. 5. As used in this act: (a) “Affiliated pharmacy” means, except as otherwise provided in this subdivision, a network pharmacy that directly, or indirectly through 1 or more intermediaries, controls, is controlled by, or is under common control […]
***** 550.817.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.817.new Definitions; M to P. Sec. 7. As used in this act: (a) “Mail-order pharmacy” means a pharmacy whose primary business is to receive prescriptions by mail, fax, or through electronic submissions, dispense drugs to enrollees through the use of the United States Postal […]
***** 550.819.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.819.new Definitions; R to W. Sec. 9. As used in this act: (a) “Rebate” means a formulary discount or remuneration attributable to the use of prescription drugs that is paid by a manufacturer or third party, directly or indirectly, to a pharmacy benefit manager […]
***** 550.821.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.821.new Pharmacy benefit manager; licensure; application requirements; modification notice; grounds for refusal, revocation, denial, or suspension; fines; notice and hearings; investigation of officers, directors and owners; renewal. Sec. 11. (1) A pharmacy benefit manager that provides services to residents of this state shall apply […]
***** 550.823.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.823.new Promulgation of rules. Sec. 13. (1) The director shall promulgate rules that are necessary or required to implement this act. (2) The rules promulgated by the director under subsection (1) must include fines, suspension of licensure, restriction of licensure, and revocation of licensure […]
***** 550.825.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.825.new Contractual responsibilities; conflict of interest; exception for certain audits. Sec. 15. (1) A pharmacy benefit manager shall exercise good faith and fair dealing in the performance of its contractual duties to a health plan or network pharmacy. A provision in a contract that […]
***** 550.827.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.827.new Pharmacy benefit manager network; report; waiver; prohibition on spread pricing and fees for electronic processing. Sec. 17. (1) A pharmacy benefit manager shall provide a reasonably adequate and accessible retail pharmacy benefit manager network for the provision of drugs for a health plan […]
***** 550.829.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.829.new Prohibited conduct. Sec. 19. (1) A pharmacy benefit manager shall not discriminate against a nonaffiliated pharmacy that is a retail pharmacy. (2) A pharmacy benefit manager shall not impose limits, including quantity limits or refill frequency limits, on an enrollee’s access to retail […]
***** 550.831.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.831.new Contractual restrictions and limitations with pharmacists or pharmacies; disclosure of costs; payment at point of sale. Sec. 21. (1) A contract between a pharmacy benefit manager and a pharmacist or a pharmacy that provides drug coverage for health plans must not prohibit or […]
***** 550.833.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.833.new Transparency report; requirements; exempt from freedom of information act; report to legislature; inapplicable to Medicaid contracts. Sec. 23. (1) Unless otherwise required more frequently by the director, by April 1, 2025 and each April 1 after that date, except as otherwise provided in […]
***** 550.837.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.837.new Maximum allowable costs; pharmacy benefit manager duties. Sec. 27. (1) For each drug that a pharmacy benefit manager establishes a maximum allowable cost, the pharmacy benefit manager shall do all of the following: (a) Provide each pharmacy subject to a maximum allowable cost […]
***** 550.838.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.838.new Authorization to conduct audit; process and duties; written report; extrapolation audit prohibition; inapplicable to certain investigations; carrier pharmacy audits not impaired or superseded. Sec. 28. (1) Subject to this section, a carrier or a pharmacy benefit manager may conduct an audit of a […]
***** 550.839.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.839.new Retail pharmacies; contractual restrictions and limitations; use of untrue, deceptive, or misleading advertisements; reversal and resubmission of claims; termination of pharmacy from pharmacy benefit manager network; retaliation prohibited; “personal representative” defined. Sec. 29. (1) A contract between a retail pharmacy and a pharmacy […]
***** 550.840.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.840.new Enforcement of act; examination and audit. Sec. 30. (1) The director shall enforce this act. (2) The director may examine or audit the relevant books and records of a pharmacy benefit manager providing claims processing services or other drug or device services for […]
***** 550.841.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.841.new Contract compliance; license requirement. Sec. 31. A contract between a pharmacy benefit manager and an insurer that exists on the date of licensure of the pharmacy benefit manager must comply with the requirements of this act as a condition of licensure for the […]
***** 550.843.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.843.new Retention schedule; records, books, papers, and other data; destruction or disposal of certain documents prohibited. Sec. 33. (1) The director shall establish a retention schedule for all records, books, papers, and other data on file with the department related to the enforcement of […]
***** 550.845.new THIS NEW SECTION IS EFFECTIVE JANUARY 1, 2024 ***** 550.845.new Scope of act. Sec. 35. This act does not apply with respect to a claim that is entirely preempted by federal law, including Medicare Part D or the employee retirement income security act of 1974, Public Law 93-406. History: 2022, Act 11, Eff. […]
