MI HB5876

Amends the Prudent Purchaser Act to require health insurance organizations to allow any pharmacy in their service area to participate in pharmacy provider panels on the same terms and conditions offered to other participating pharmacies.

Prohibits organizations from prohibiting, limiting, or penalizing insured members who select any pharmacy that has agreed to participate in the provider panel, and prohibits requiring mail-order pharmacy use as a condition of payment.

Requires organizations to provide 30-day advance written notice to the director, board of pharmacy, and all pharmacies in the service area before establishing new pharmacy provider panels, and to offer equal participation terms to all requesting pharmacies.

Allows pharmacies to request participation in provider panels at any time and prohibits organizations from denying participation if the pharmacy agrees to the same terms as other panel members; pharmacies cannot impose different copayments or coinsurance on members than other panel pharmacies.

Establishes civil penalties up to $50,000 per violation for organizations, criminal penalties of up to 4 years imprisonment or $50,000 fine for certain violations, and private right of action allowing injured parties to recover actual damages, interest, costs, and attorney fees (treble damages if violation was flagrant or anticompetitive).