HB 6493 Summary

• Establishes the "Pharmacy Benefit Management Act" requiring pharmacy benefit managers (PBMs) operating in Michigan to obtain and maintain a certificate of authority from the Department of Insurance and Financial Services.

• Imposes licensing fees of $200 for initial application and $25 for annual certificate renewal, with annual renewal required.

• Requires PBMs to use transparent prescription drug pricing standards updated at least weekly, include sources used to determine pricing, and establish appeal processes allowing pharmacies 21 days to appeal and requiring resolution within 10 business days.

• Prohibits PBMs from mandating use of specific pharmacies in which the PBM has ownership interest, requiring pharmacies to participate in multiple networks simultaneously, automatically enrolling/disenrolling pharmacies without written consent, and restricting 90-day supplies at network pharmacies.

• Establishes audit standards including 2-week advance notice, same sampling procedures across pharmacies, prohibition on extrapolation audits, 60-day preliminary report deadline, 30-day pharmacy response period, and written appeals process; takes effect 90 days after enactment.