Michigan House Bill HB5338

Michigan 2023-2024 Regular Session

• Introduced: 11/14/23
• Refer: 11/14/23

Caption

Insurance: other; an enrollee's defined cost sharing for prescription drugs; provide for. Amends secs. 5, 7 & 9 of 2022 PA 11 (MCL 550.815 et seq.) & adds sec. 10.

Impact

The proposed changes primarily aim to enhance the financial fairness and accountability of pharmacy benefit managers (PBMs) by obligating them to pass on rebates to health plan enrollees. By establishing a maximum allowable reimbursement for pharmacies and detailing the cost-sharing calculations, the legislation aims to curtail any potential excessive pricing strategies employed by PBMs. These adjustments can have far-reaching implications for the relationship between pharmacies, insurance providers, and consumers, promoting a more equitable healthcare system.

Summary

House Bill 5338 seeks to amend the existing Pharmacy Benefit Manager Licensure and Regulation Act of Michigan, by introducing new provisions to manage the costs associated with prescription drugs. A significant component of the bill focuses on how an enrollee's cost sharing is calculated for prescription drugs at the point of sale. The bill mandates that cost sharing must reflect a price that is reduced by the total of all rebates related to the particular drug, ensuring transparency and potential savings for enrollees, who may benefit financially from this structure.

Contention

Despite the potentially positive financial impact on consumers, the bill has also spurred some debates regarding the operational feasibility and implications for pharmacy benefit managers. Stakeholders may be concerned about the operational burden of new requirements for cost reporting and enforcement of penalties for non-compliance. Moreover, discussions may arise around whether the bill provides sufficient protections to ensure that PBMs continue to fulfill their roles effectively without compromising the quality and accessibility of prescription drug services.