HB 4348 Summary

• Establishes licensing and regulatory framework for pharmacy benefit managers (PBMs) operating in Michigan under the Department of Insurance and Financial Services, with biennial renewable licenses and financial viability requirements.

• Prohibits spread pricing (charging health plans different amounts than paid to pharmacies), requires PBMs to provide accessible retail pharmacy networks, and bans discrimination against non-affiliated pharmacies.

• Mandates annual transparency reporting to the director on aggregate rebates received, retained rebates, and fees, with aggregate data to be reported publicly by August 1 each year starting 2025.

• Establishes maximum allowable cost (MAC) list requirements including 7-day updates, pharmacy appeals processes, and limitations on audits with restrictions on extrapolation audits, clerical error recoupments, and auditor compensation based on recovery amounts.

• Requires good faith performance of contracts, prohibits retaliatory conduct against pharmacists/pharmacies, restricts claim reversals to 90 days post-adjudication, and caps monthly fines for license suspension at $20,000 with an effective date of January 1, 2024.