Michigan Laws > Chapter 550 > Act 11 of 2022 – Pharmacy Benefit Manager Licensure and Regulation Act
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Terms Used In Michigan Laws > Chapter 550 > Act 11 of 2022 - Pharmacy Benefit Manager Licensure and Regulation Act
- Affiliated pharmacy: means , except as otherwise provided in this subdivision, a network pharmacy that directly, or indirectly through 1 or more intermediaries, controls, is controlled by, or is under common control with, a pharmacy benefit manager. See Michigan Laws 550.815
- Aggregate retained rebate percentage: means the percentage of all rebates received by a pharmacy benefit manager from all manufacturers, that is not passed on to the pharmacy benefit manager's Michigan health plan or insurer clients. See Michigan Laws 550.815
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
- Carrier: means that term as defined in section 3701 of the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.815
- Claim: means a request for payment for administering, filling, or refilling a drug or for providing a pharmacy service or a medical supply or device to an enrollee. See Michigan Laws 550.815
- Claims processing services: means the administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include any of the following:
(i) Receiving payments for pharmacist services. See Michigan Laws 550.815Contract: A legal written agreement that becomes binding when signed. Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name. Covered person: means a person that is insured in a health plan. See Michigan Laws 550.815 Department: means the department of insurance and financial services. See Michigan Laws 550.815 Director: means the director of the department. See Michigan Laws 550.815 Enrollee: means that term as defined in section 116 of the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.815 Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other. Financially viable: means that 1 of the following conditions is met:
(i) The pharmacy benefit manager has received an unqualified opinion from an independent public accountant showing it is solvent based on generally accepted accounting principles. See Michigan Laws 550.815Fraud: Intentional deception resulting in injury to another. Freedom of Information Act: A federal law that mandates that all the records created and kept by federal agencies in the executive branch of government must be open for public inspection and copying. The only exceptions are those records that fall into one of nine exempted categories listed in the statute. Source: OCC Health plan: means a qualified health plan as that term is defined in section 1261 of the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.815 in writing: shall be construed to include printing, engraving, and lithographing; except that if the written signature of a person is required by law, the signature shall be the proper handwriting of the person or, if the person is unable to write, the person's proper mark, which may be, unless otherwise expressly prohibited by law, a clear and classifiable fingerprint of the person made with ink or another substance. See Michigan Laws 8.3q Individual responsible for the conduct of affairs of the pharmacy benefit manager: means any of the following:
(i) A member of the board of directors, board of trustees, executive committee, or other governing board or committee. See Michigan Laws 550.815Insurer: means an insurer that delivers, issues for delivery, or renews in this state a health plan that provides drug coverage under the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.815 Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity. Mail-order pharmacy: means a pharmacy whose primary business is to receive prescriptions by mail, fax, or through electronic submissions, dispense drugs to enrollees through the use of the United States Postal Service or other common carrier services, and provide consultation with patients electronically rather than face-to-face. See Michigan Laws 550.817 Manufacturer: means that term as defined in section 17706 of the public health code, 1978 PA 368, MCL 333. See Michigan Laws 550.817 Maximum allowable cost: means the maximum amount that a pharmacy benefit manager will reimburse a network pharmacy for the ingredient cost for a generic drug. See Michigan Laws 550.817 Maximum allowable cost list: means a listing of drugs used by a pharmacy benefit manager, directly or indirectly, to set the maximum allowable cost. See Michigan Laws 550.817 month: means a calendar month; the word "year" a calendar year; and the word "year" alone shall be equivalent to the words "year of our Lord". See Michigan Laws 8.3j Multiple source drug: means a therapeutically equivalent drug that is available from 1 or more of the following:
(i) At least 1 brand-named manufacturer and at least 1 generic manufacturer. See Michigan Laws 550.817Network pharmacy: means a retail pharmacy or other pharmacy that contracts directly or through a pharmacy services administration organization with a pharmacy benefit manager. See Michigan Laws 550.817 Nolo contendere: No contest-has the same effect as a plea of guilty, as far as the criminal sentence is concerned, but may not be considered as an admission of guilt for any other purpose. Nonaffiliated pharmacy: means a network pharmacy that directly, or indirectly through 1 or more intermediaries, does not control, is not controlled by, and is not under common control with, a pharmacy benefit manager. See Michigan Laws 550.817 Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period. Oversight: Committee review of the activities of a Federal agency or program. Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses. Person: means an individual, partnership, corporation, association, governmental entity, or any other legal entity. See Michigan Laws 550.817 Pharmacist: means that term as defined in section 17707 of the public health code, 1978 PA 368, MCL 333. See Michigan Laws 550.817 Pharmacist services: means products, goods, and services, or any combination of products, goods, and services, provided as a part of the practice of pharmacy. See Michigan Laws 550.817 Pharmacy: means that term as defined in section 17707 of the public health code, 1978 PA 368, MCL 333. See Michigan Laws 550.817 pharmacy benefit manager: means an entity that contracts with a pharmacy or a pharmacy services administration organization on behalf of a health plan or carrier to provide pharmacy health services to individuals covered by the health plan or carrier or administration that includes, but is not limited to, any of the following:
(i) Contracting directly or indirectly with pharmacies to provide drugs to enrollees or other covered persons. See Michigan Laws 550.817Pharmacy benefit manager network: means a network of pharmacists or pharmacies that are offered by an agreement or contract to provide pharmacist services. See Michigan Laws 550.817 Pharmacy services administration organization: means an entity that provides contracting and other administrative services relating to prescription drug benefits to pharmacies. See Michigan Laws 550.817 Plan sponsor: means that term as defined in section 7705 of the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.817 Plea: In a criminal case, the defendant's statement pleading "guilty" or "not guilty" in answer to the charges, a declaration made in open court. Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC Practice of pharmacy: means that term as defined in section 17707 of the public health code, 1978 PA 368, MCL 333. See Michigan Laws 550.817 Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide. Rebate: means a formulary discount or remuneration attributable to the use of prescription drugs that is paid by a manufacturer or third party, directly or indirectly, to a pharmacy benefit manager after a claim has been adjudicated at a pharmacy. See Michigan Laws 550.819 Retail pharmacy: means a pharmacy that dispenses prescription drugs to the public at retail primarily to individuals that reside in close proximity to the pharmacy, typically by face-to-face interaction with the individual or the individual's caregiver. See Michigan Laws 550.819 Rule: means a rule promulgated under the administrative procedures act of 1969, 1969 PA 306, MCL 24. See Michigan Laws 550.819 Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims. Specialty pharmacy: means a pharmacy that dispenses specialty drugs to patients and that is nationally accredited by an independent third party. See Michigan Laws 550.819 Spread pricing: means the model of prescription drug pricing in which a pharmacy benefit manager charges a health plan a contracted price for prescription drugs, and the contracted price for the prescription drugs differs from the amount the pharmacy benefit manager directly or indirectly pays the pharmacist or pharmacy for pharmacist services. See Michigan Laws 550.819 state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories belonging to the United States; and the words "United States" shall be construed to include the district and territories. See Michigan Laws 8.3o Statute: A law passed by a legislature. third party: means a person that is not an enrollee or insured in a health plan. See Michigan Laws 550.819 United States: shall be construed to include the district and territories. See Michigan Laws 8.3o Wholesale distributor: means that term as defined in section 17709 of the public health code, 1978 PA 368, MCL 333. See Michigan Laws 550.819