MI HB5006

Department of Human Services prohibited from contracting with Medicaid managed care organizations that use pharmacy benefit managers failing to meet specified reimbursement standards for independent pharmacies with 7 or fewer retail outlets.

Independent pharmacies must receive reimbursement based on national average drug acquisition cost plus professional dispensing fee comparable to that in 2020 PA 166, or alternative methodologies for brand and generic drugs when acquisition cost pricing unavailable.

Pharmacy benefit managers required to reimburse claims at rates no less than the rate in effect at original claim submission, transition to transparent pass-through pricing models disclosing administrative fees, and prohibited from terminating independent pharmacy contracts solely due to additional professional dispensing fees.

Pharmacy benefit managers must freeze new pharmacy administration fees and cap existing fee increases to inflation rate (federal actions exempt), and prohibited from creating new fees.

Pharmacy benefit managers receiving Medicaid reimbursement must submit annual reports to the department by January 15 detailing prescriptions dispensed, wholesale acquisition costs, rebates and discounts, administrative fees received, retained amounts, and pharmacy reimbursements; department reports aggregated data to legislature by March 1 annually.