Michigan Laws 550.815 – Definitions; A to I
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Terms Used In Michigan Laws 550.815
- Affiliated pharmacy: means , except as otherwise provided in this subdivision, a network pharmacy that directly, or indirectly through 1 or more intermediaries, controls, is controlled by, or is under common control with, a pharmacy benefit manager. See Michigan Laws 550.815
- Aggregate retained rebate percentage: means the percentage of all rebates received by a pharmacy benefit manager from all manufacturers, that is not passed on to the pharmacy benefit manager's Michigan health plan or insurer clients. See Michigan Laws 550.815
- Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Department: means the department of insurance and financial services. See Michigan Laws 550.815
- Director: means the director of the department. See Michigan Laws 550.815
- Enrollee: means that term as defined in section 116 of the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.815
- Health plan: means a qualified health plan as that term is defined in section 1261 of the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.815
- Insurer: means an insurer that delivers, issues for delivery, or renews in this state a health plan that provides drug coverage under the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.815
- Network pharmacy: means a retail pharmacy or other pharmacy that contracts directly or through a pharmacy services administration organization with a pharmacy benefit manager. See Michigan Laws 550.817
- Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
- Person: means an individual, partnership, corporation, association, governmental entity, or any other legal entity. See Michigan Laws 550.817
- Pharmacist: means that term as defined in section 17707 of the public health code, 1978 PA 368, MCL 333. See Michigan Laws 550.817
- Pharmacist services: means products, goods, and services, or any combination of products, goods, and services, provided as a part of the practice of pharmacy. See Michigan Laws 550.817
- Pharmacy: means that term as defined in section 17707 of the public health code, 1978 PA 368, MCL 333. See Michigan Laws 550.817
- pharmacy benefit manager: means an entity that contracts with a pharmacy or a pharmacy services administration organization on behalf of a health plan or carrier to provide pharmacy health services to individuals covered by the health plan or carrier or administration that includes, but is not limited to, any of the following:
(i) Contracting directly or indirectly with pharmacies to provide drugs to enrollees or other covered persons. See Michigan Laws 550.817Rebate: means a formulary discount or remuneration attributable to the use of prescription drugs that is paid by a manufacturer or third party, directly or indirectly, to a pharmacy benefit manager after a claim has been adjudicated at a pharmacy. See Michigan Laws 550.819 state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories belonging to the United States; and the words "United States" shall be construed to include the district and territories. See Michigan Laws 8.3o
As used in this act:
(a) “Affiliated pharmacy” means, except as otherwise provided in this subdivision, a network pharmacy that directly, or indirectly through 1 or more intermediaries, controls, is controlled by, or is under common control with, a pharmacy benefit manager. As used in section 19, affiliated pharmacy does not include a pharmacy that controls, is controlled by, or is under common control with, a hospital as that term is defined in section 20106 of the public health code, 1978 PA 368, MCL 333.20106.
(b) “Aggregate retained rebate percentage” means the percentage of all rebates received by a pharmacy benefit manager from all manufacturers, that is not passed on to the pharmacy benefit manager’s Michigan health plan or insurer clients. Aggregate retained rebate percentage must be expressed without disclosing any identifying information regarding any health plan, drug, or therapeutic class, and must be calculated as follows:
(i) Calculate the aggregate dollar amount of all rebates that the pharmacy benefit manager received during the prior calendar year from all manufacturers and did not pass through to the pharmacy benefit manager’s Michigan health plan or insurer clients.
(ii) Divide the result of the calculation under subparagraph (i) by the aggregate dollar amount of all rebates that the pharmacy benefit manager received during the prior calendar year from all manufacturers.
(c) “Carrier” means that term as defined in section 3701 of the insurance code of 1956, 1956 PA 218, MCL 500.3701.
(d) “Claim” means a request for payment for administering, filling, or refilling a drug or for providing a pharmacy service or a medical supply or device to an enrollee.
(e) “Claims processing services” means the administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include any of the following:
(i) Receiving payments for pharmacist services.
(ii) Making payments to pharmacists or pharmacies for pharmacist services.
(iii) Receiving and making the payments described in subparagraphs (i) and (ii).
(f) “Covered person” means a person that is insured in a health plan.
(g) “Department” means the department of insurance and financial services.
(h) “Director” means the director of the department.
(i) “Enrollee” means that term as defined in section 116 of the insurance code of 1956, 1956 PA 218, MCL 500.116.
(j) “Financially viable” means that 1 of the following conditions is met:
(i) The pharmacy benefit manager has received an unqualified opinion from an independent public accountant showing it is solvent based on generally accepted accounting principles.
(ii) If no independent public accountant opinion is obtained, the pharmacy benefit manager remains solvent after adjusting for goodwill and intangible assets.
(k) “Health plan” means a qualified health plan as that term is defined in section 1261 of the insurance code of 1956, 1956 PA 218, MCL 500.1261.
(l) “Individual responsible for the conduct of affairs of the pharmacy benefit manager” means any of the following:
(i) A member of the board of directors, board of trustees, executive committee, or other governing board or committee.
(ii) A principal officer for a corporation or a partner or member for a partnership, association, or limited liability company.
(iii) A shareholder or member holding directly or indirectly 10% or more of the voting stock, voting securities, or voting interest of the pharmacy benefit manager.
(iv) Any person who exercises control over the affairs of the pharmacy benefit manager.
(m) “Insurer” means an insurer that delivers, issues for delivery, or renews in this state a health plan that provides drug coverage under the insurance code of 1956, 1956 PA 218, MCL 500.100 to 500.8302.