Bill > HB5006

This bill amends the Social Welfare Act to prohibit the Michigan Department of Health and Human Services (MDHHS) from entering into a Medicaid managed care contract with a pharmacy benefit manager (PBM) that does not meet certain requirements. The key provisions include requiring the PBM to: 1) Use a pharmacy reimbursement methodology that provides a professional dispensing fee comparable to the state's Medicaid dispensing fee for pharmacies with 7 or fewer retail outlets. 2) Reimburse pharmacies at a rate not less than the original claim adjudication. 3) Transition to a transparent pass-through pricing model where administrative fees are disclosed. 4) Agree to not create new or increase current pharmacy administration fees beyond the rate of inflation. 5) Not terminate contracts with smaller pharmacies solely due to the additional dispensing fee. The bill also requires PBMs that receive Medicaid reimbursements to annually report detailed information about prescription volumes, drug costs, rebates, and reimbursements to MDHHS, which must then submit the data to the state legislature.