HOUSE BILL No. 4480


     April 15, 1999, Introduced by Reps. DeRossett, Ehardt, Birkholz, Howell, Caul, Woronchak, Richardville, Shackleton, Gilbert, Julian, Faunce, Bisbee, Kowall, Hager, Van Woerkom and Scranton and referred to the Committee on Health Policy.


        A bill to amend 1978 PA 368, entitled

   "Public health code,"

   (MCL 333.1101 to 333.25211) by adding section 21053f.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1         SEC. 21053F.  A HEALTH MAINTENANCE ORGANIZATION THAT PRO-

 2    VIDES COVERAGE FOR PRESCRIPTION DRUGS AND LIMITS THOSE BENEFITS

 3    TO DRUGS INCLUDED IN A FORMULARY, SHALL DO ALL OF THE FOLLOWING:

 4         (A) ENSURE PARTICIPATION OF AFFILIATED PHYSICIANS AND PHAR-

 5    MACISTS IN THE DEVELOPMENT OF THE FORMULARY.

 6         (B) DISCLOSE TO HEALTH PROFESSIONALS AND UPON REQUEST TO

 7    ENROLLEES THE NATURE OF THE FORMULARY RESTRICTIONS.

 8         (C) PROVIDE FOR EXCEPTIONS FROM THE FORMULARY LIMITATION

 9    WHEN A NONFORMULARY ALTERNATIVE IS MEDICALLY INDICATED.  THIS

10    SUBDIVISION DOES NOT PREVENT A HEALTH MAINTENANCE ORGANIZATION




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 1    FROM ESTABLISHING HIGHER COST-SHARING FOR NONFORMULARY

 2    ALTERNATIVES.




















































   03045'99          Final page.                            DKH