February 19, 2015, Introduced by Senators O'BRIEN, HILDENBRAND, SCHUITMAKER, KNEZEK and HUNE and referred to the Committee on Insurance.
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 allow and apply a prorated daily
cost-sharing rate for prescription drugs that are dispensed by an
in-network pharmacy for less than a 30-day supply if the prescriber
or the pharmacist indicates that the fill or refill for less than a
30-day supply is in the best interests of the patient or is for the
purpose of synchronizing the patient's prescription drugs for
chronic health conditions.
(2) An insurer or health maintenance organization described in
subsection (1) shall not reimburse or pay a dispensing fee for a
prescription drug that is based on a payment structure that
incorporates a prorated dispensing fee for a prescription drug,
which dispensing fee is determined by calculating the number of
days' supply of the prescription drug dispensed. The insurer or
health maintenance organization shall only reimburse or pay a
dispensing fee for a prescription drug that is based on a payment
structure that determines a dispensing fee for each prescription
dispensed.
(3) An insurer or health maintenance organization described in
subsection (1) shall not deny coverage for the dispensing of a
prescription drug that is prescribed for the treatment of a chronic
health condition, which prescription is issued in accordance with a
plan among the patient, the prescriber, and a pharmacist for the
purpose of synchronizing the patient's multiple prescription drugs
for chronic health conditions.
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 180 days after the date
this amendatory act is enacted into law.