PHARMACY BENEFIT MANAGERS                                                                                                                   H.B. 4348 (S-1):

                                                                                                                                                                                                      SUMMARY OF BILL

                                                                                                                                                                        REPORTED FROM COMMITTEE

House Bill 4348 (Substitute S-1 as reported)

Sponsor:   Representative Julie Calley

House Committee:   Health Policy

Senate Committee:   Health Policy and Human Services

CONTENT

The bill would enact the "Pharmacy Benefit Manager Licensure and Regulation Act" to do the following:

 --       Provide for the licensure of pharmacy benefit managers (PBMs) in Michigan.

 --       Require a person seeking licensure as a PBM to submit to the Director of the Department of Insurance and Financial Services (DIFS) an application containing specified information.

 --       Allow the Director to refuse to issue a license if he or she determined that the PBM was not financially viable or that the PBM or any individual responsible for the conduct of the PBM's affairs had had a PBM certificate of authority or license denied or revoked for cause in another state.

 --       Allow the Director to deny, suspend, or revoke a PBM license under certain circumstances.

 --       Require an applicant seeking to renew a PBM license to submit to the Director a renewal application, a renewal schedule and fee, and a retail PBM network adequacy report.

 --       Prescribe the duties and responsibilities of a PBM licensed in the State and prescribe certain prohibited actions.

 --       Require a PBM to provide a reasonably adequate and accessible retail PBM network for the provision of drugs for a health plan that would have to provide for convenient enrollee access to pharmacies within a reasonable distance from a enrollee's residence, and allow a PBM to apply for a waiver if it were unable to meet the network adequacy requirements.

 --       Prohibit a PBM from conducting spread pricing in the State.

 --       Prohibit a PMB from charging a pharmacy or pharmacist a fee to process a claim electronically.

 --       Require a PBM to file an annual transparency report with the Director that contained specified information for the preceding calendar year.

 --       Require the Director to prepare an annual report based on the information he or she received under the Act and submit it to the Legislature.

 --       Require a PBM to take certain actions for each drug that the PBM established a minimum allowable cost, and require the PBM to ensure that certain conditions were met before the PBM placed or continued a drug on a maximum allowable cost list.

 --       Allow a carrier or a PBM to conduct an audit of a pharmacy in Michigan and prescribe the process for conducting an audit.

 --       Prescribe certain record retention procedures.

 --       Require the Director to promulgate rules  tha