Bills:
Community
pharmacists have long expressed concerns regarding business practices related
to pharmacy benefit managers (PBMs) within the state. Well, I have news for
you: your legislators are listening.
Senate Bills (SBs) 999, 1000, 1001 and 1002 sponsored by Sens. Tom Casperson, Tonya
Schuitmaker and Bruce Caswell were introduced during the last week of the
legislative session. The bills address PBM licensure (999), pharmacy audits
(1000), Maximum Allowable Cost (MAC) pricing (1001) and mandatory mail-order/closed
networks (1002).
These
bills are the latest efforts to establish fair business practices between
pharmacies and PBMs. The ultimate goal of these legislative efforts is to
ensure that pharmacies can continue to provide high-quality services that are
both accessible and affordable for their patients. Below I have broken down
each of the bills and their desired effects.
SB 999 would require PBMs to register as third-party
administrators and would legally define terms such as “Pharmacy Benefit
Manager,” “Maximum Allowable Cost Price,” “Multiple Source Drug” and “Orange
Book.” Currently, not all PBMs are registered as third-party administrators,
and these terms used in the day-to-day operations of pharmacies are
inadequately defined by current laws and regulations.
SB 1000 regulates pharmacy auditing
practices. MPA recognizes that audits are important in the regulation of
pharmacies. Proper audit practices help ensure accuracy of delivered services,
and combat fraud, waste and abuse. It is important, however, that these audits
are conducted fairly and do not interfere with the delivery of patient care
services. SB 1000 bares marked similarities to SB 42, which was introduced in 2013 by Sen. Caswell.
SB 1001 specifies certain disclosure and
updated requirements related to MAC pricing. Unlike SB 656, which pertained only to the Department of Community Health
and contracted health plans, SB 1001 would affect all PBMs operating in
Michigan.
SB 1002 prohibits plans from incentivizing a
beneficiary to use a certain retail pharmacy or mail-order warehouse, or
excluding pharmacy providers from their network.
All
four of these bills have been referred to the Committee on Insurance chaired by
Sen. Joe Hune.
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