Bill > HB5303

This bill modifies Michigan's Medicaid managed care regulations regarding pharmacy benefit managers (PBMs), which are intermediaries that manage prescription drug benefits for health insurance plans. The bill requires that Medicaid managed care organizations work with PBMs that follow specific reimbursement rules for smaller pharmacies (those with 7 or fewer retail outlets). These rules include using a reimbursement methodology based on the lowest of several pricing options, such as national average drug acquisition cost, wholesale acquisition cost, or the pharmacy's usual and customary charge. The bill adds new provisions for reimbursing brand and generic drugs when standard pricing is unavailable, mandates transparent pricing where administrative fees are disclosed, prevents PBMs from creating new or increasing existing pharmacy administration fees beyond inflation, and prohibits terminating contracts with small Michigan pharmacies solely due to additional professional dispensing fees. The bill sets February 13, 2024, as the implementation date and aims to protect smaller pharmacies by ensuring fair compensation and preventing discriminatory practices in Medicaid prescription drug coverage.

Health and Social Services

https://legislature.mi.gov/Bills/Bill?ObjectName=2025-HB-5303