As an important and exciting update, independent pharmacies in Michigan have reason to celebrate as House Bill 4348 (“Bill”) was passed by the Senate on February 16, 2022 and will now make its way to the desk of Governor Gretchen Whitmer to be signed into law. Governor Whitmer stated, “We must continue working together to improve transparency in health care, hold accountable people and corporations profiting from skyrocketing prices, and make life-saving, essential medication like insulin affordable for every Michigander who needs it. I look forward to signing this legislation, and I am grateful to my Prescription Drug Task Force for all the work they did to provide a solid set of recommendations, including a few that were included in this legislation to help Michiganders save money on prescription drugs.” As previously discussed by Frier Levitt, the Bill will benefit independent pharmacies when it takes effect on January 1, 2023 by:
- Clearly defining the term “Maximum Allowable Cost” (MAC);
- Limiting the ability of PBMs to continue to assert that MAC lists are confidential;
- Requiring a PBM to communicate the final reimbursement amount at the point of sale;
- Prohibiting PBMs from reimbursing a non-affiliated pharmacy an amount less than an affiliated pharmacy for the same service; and
- Establishing a reasonable appeals process for pharmacies to challenge PBM conduct.
This Bill is a substantial improvement to Michigan’s current PBM laws and would provide independent pharmacies with several new tools to combat improper practices by PBM. Thus, independent pharmacies in Michigan have reason to rejoice as 2023 approaches and take steps now to become familiar with the Bill so that they are prepared to take action, if needed, in 2023.
How Frier Levitt Can Help
Frier Levitt represents numerous pharmacies across the United States in challenging PBM audits, network access, reimbursement practices and has extensive knowledge on all aspects of the pharmacy-PBM relationship. Contact us today to speak with an attorney about how your pharmacy can leverage the various laws and protections afforded to pharmacies, including state PBM laws in effect in numerous states, including Michigan, in addition to important federal laws which regulate PBM conduct.
