HOUSE BILL NO. 5944

July 21, 2020, Introduced by Reps. Frederick, Vaupel, Wozniak, Yaroch and Tyrone Carter and referred to the Committee on Health Policy.

"The insurance code of 1956,"

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

the people of the state of michigan enact:

Sec. 3406v. (1) Subject to section 4 of the health care false claims act, 1984 PA 323, MCL 752.1004, a health insurance policy delivered, issued for delivery, or renewed in this state that provides coverage for prescription drugs must apply any amount paid by the insured or paid on behalf of the insured by another person that is not an unauthorized payer when calculating the insured's overall contribution to any out-of-pocket maximum or any cost-sharing requirement.

(2) This section applies to a health insurance policy delivered, issued for delivery, or renewed in this state after December 31, 2021.

(3) As used in this section:

(a) "Cost-sharing requirement" means any copayment, coinsurance, deductible, or annual limitation on cost sharing, including, but not limited to, a limitation subject to 42 USC 18022(c) and 300gg-6(b), required by or on behalf of an insured in order to receive a specific health care service, including a prescription drug, covered by a health insurance policy.

(b) "Paid" does not include any form of direct support offered by a manufacturer as that term is defined in section 17706 of the public health code, 1978 PA 368, MCL 333.17706.

(c) "Unauthorized payer" means a person that is prohibited from paying for prescription drug coverage by any of the following reasons:

(i) Federal law.

(ii) The law of this state.

(iii) Contractual requirements.