Michigan Laws 550.829 – Prohibited conduct
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Terms Used In Michigan Laws 550.829
- 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
- Carrier: means that term as defined in section 3701 of the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.815
- Contract: A legal written agreement that becomes binding when signed.
- Covered person: means a person that is insured in a health plan. See Michigan Laws 550.815
- Department: means the department of insurance and financial services. 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
- Nonaffiliated pharmacy: means a network pharmacy that directly, or indirectly through 1 or more intermediaries, does not control, is not controlled by, and is not under common control with, a pharmacy benefit manager. See Michigan Laws 550.817
- 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
- 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 550.817Retail pharmacy: means a pharmacy that dispenses prescription drugs to the public at retail primarily to individuals that reside in close proximity to the pharmacy, typically by face-to-face interaction with the individual or the individual's caregiver. 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
(1) A pharmacy benefit manager shall not discriminate against a nonaffiliated pharmacy that is a retail pharmacy.
(2) A pharmacy benefit manager shall not impose limits, including quantity limits or refill frequency limits, on an enrollee‘s access to retail prescription drugs that differ based solely on whether the pharmacy benefit manager has an ownership interest in a pharmacy or the pharmacy has an ownership interest in the pharmacy benefit manager.
(3) A pharmacy benefit manager or carrier shall not prohibit a 340B Program entity or a pharmacy that has a license in good standing in this state under contract with a 340B Program entity from participating in the pharmacy benefit manager’s or carrier’s provider network solely because it is a 340B Program entity or a pharmacy under contract with a 340B Program entity. A pharmacy benefit manager or carrier shall not reimburse a 340B Program entity or a pharmacy under contract with a 340B Program entity differently than other similarly situated pharmacies. As used in this subsection, “340B Program entity” means an entity authorized to participate in the federal 340B Program under section 340B of the public health service act, 42 USC 256b.
(4) Unless required by applicable law or as required under Medicaid by the department of health and human services, a carrier, health plan, or pharmacy benefit manager shall not require an enrollee or covered person to use only an affiliated pharmacy that is a retail pharmacy.
(5) A carrier, health plan, pharmacy, or pharmacy benefit manager shall not financially induce an enrollee or covered person or prescriber to transfer an enrollee or covered person prescription to a retail affiliated pharmacy. As used in this subsection, “prescriber” means that term as defined in section 17708 of the public health code, 1978 PA 368, MCL 333.17708.
(6) A carrier, health plan, or pharmacy benefit manager shall not require a retail nonaffiliated pharmacy to transfer an enrollee’s or covered person’s retail prescription to a retail affiliated pharmacy without the prior consent of the enrollee or patient.
(7) A pharmacy benefit manager shall not unreasonably restrict an enrollee or covered person from using a particular network retail pharmacy for the purposes of receiving pharmacist services covered by the enrollee’s or covered person’s health plan.
(8) Before a prescription is dispensed, an affiliated pharmacy shall disclose to an enrollee or covered person that the affiliated pharmacy is an affiliated pharmacy and that the enrollee or covered person is not obligated to use the affiliated pharmacy.
(9) This section does not prohibit a health plan or carrier from doing any of the following:
(a) Offering customized pharmacy network options to its clients.
(b) Offering mail order of specialty treatments.
(c) Establishing a tiered network.