MI HB4276

Department of Human Services cannot contract with Medicaid managed care organizations using pharmacy benefit managers that do not comply with specified reimbursement and fee requirements for Michigan pharmacies with 7 or fewer retail outlets.

Pharmacy benefit managers must reimburse Michigan independent pharmacies using the lesser of: national average drug acquisition cost plus professional dispensing fee, wholesale acquisition cost plus professional dispensing fee, or usual and customary charges.

Pharmacy benefit managers must transition to transparent pass-through pricing models disclosing administrative fees as a percentage of professional dispensing costs, and cannot create new pharmacy administration fees or increase existing fees beyond the inflation rate.

Pharmacy benefit managers must submit annual reports to the Department by January 15 detailing prescription volumes, drug acquisition costs, rebates and discounts, administrative fees, amounts retained, and pharmacy reimbursement amounts for the previous fiscal year.

Department shall provide aggregated pharmacy benefit manager data to legislature and state budget office by March 1 annually; nonaggregated information remains confidential and is not a public record.