SB-0150, As Passed House, March 1, 2016

SUBSTITUTE FOR

SENATE BILL NO. 150

     A bill to amend 1956 PA 218, entitled

"The insurance code of 1956,"

(MCL 500.100 to 500.8302) by adding section 3406t.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

     Sec. 3406t. (1) An insurer that delivers, issues for delivery,

or renews in this state an expense-incurred hospital, medical, or

surgical group or individual policy or certificate that provides

prescription drug coverage, or a health maintenance organization

that offers a group or individual contract that provides

prescription drug coverage, shall provide a program for

synchronizing multiple maintenance prescription drugs for an

insured or enrollee if both of the following are met:

     (a) The insured or enrollee, the insured's or enrollee's

physician, and a pharmacist agree that synchronizing the insured's

or enrollee's multiple maintenance prescription drugs for the

treatment of a chronic long-term care condition is in the best

interests of the insured or enrollee for the management or

treatment of a chronic long-term care condition.

     (b) The insured's or enrollee's multiple maintenance

prescription drugs meet all of the following requirements:

     (i) Are covered by the policy, certificate, or contract

described in this section.

     (ii) Are used for the management and treatment of a chronic

long-term care condition and have authorized refills that remain

available to the insured or enrollee.

     (iii) Except as otherwise provided in this subparagraph, are

not controlled substances included in schedules 2 to 5 under

sections 7214, 7216, 7218, and 7220 of the public health code, 1978

PA 368, MCL 333.7214, 333.7216, 333.7218, and 333.7220. This

subparagraph does not apply to anti-epileptic prescription drugs.

     (iv) Meet all prior authorization requirements specific to the

maintenance prescription drugs at the time of the request to

synchronize the insured's or enrollee's multiple maintenance

prescription drugs.

     (v) Are of a formulation that can be effectively split over

required short fill periods to achieve synchronization.

     (vi) Do not have quantity limits or dose optimization criteria

or requirements that will be violated when synchronizing the

insured's or enrollee's multiple maintenance prescription drugs.

     (2) An insurer or health maintenance organization described in

subsection (1) shall apply a prorated daily cost-sharing rate for

maintenance prescription drugs that are dispensed by an in-network

pharmacy for the purpose of synchronizing the insured's or

enrollee's multiple maintenance prescription drugs.

     (3) An insurer or health maintenance organization described in

subsection (1) shall not reimburse or pay any dispensing fee that

is prorated. The insurer or health maintenance organization shall

only pay or reimburse a dispensing fee that is based on each

maintenance prescription drug dispensed.

     Enacting section 1. This amendatory act applies to policies,

certificates, and contracts delivered, executed, issued, amended,

adjusted, or renewed in this state, or outside of this state if

covering residents of this state, beginning 365 days after the date

this amendatory act is enacted into law.