Michigan Laws 550.831 – Contractual restrictions and limitations with pharmacists or pharmacies; disclosure of costs; payment at point of sale
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Terms Used In Michigan Laws 550.831
- 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
- Contract: A legal written agreement that becomes binding when signed.
- Covered person: means a person that is insured in a health plan. 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
- 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
- Network 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
- 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 550.817
(1) A contract between a pharmacy benefit manager and a pharmacist or a pharmacy that provides drug coverage for health plans must not prohibit or restrict a pharmacy or pharmacist from, or penalize a pharmacy or pharmacist for, disclosing to a covered person or enrollee health care information that the pharmacy or pharmacist considers appropriate regarding any of the following:
(a) The nature of the treatment or the risks or the alternatives to the treatment.
(b) The availability of alternate therapies, consultations, or tests.
(2) A pharmacy benefit manager shall not prohibit a pharmacy or pharmacist from discussing information regarding the total cost for pharmacist services for a drug or from selling a more affordable alternative to the covered person or enrollee if a more affordable alternative is available.
(3) A carrier, health plan, or pharmacy benefit manager shall not require a covered person or enrollee to make a payment for a prescription drug at the point of sale in an amount greater than the lesser of the following:
(a) The applicable copayment, coinsurance, and deductible.
(b) The final reimbursement amount to the network pharmacy.