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Michigan lawmakers unveil bills to curb health care costs

February 25, 2021 GMT

LANSING, Mich. (AP) — A Republican legislative leader and other lawmakers on Wednesday unveiled bipartisan measures they said are designed to lower prescription drug prices, bring parity in insurance coverage of chemotherapy and improve the quality of health care.

The sweeping 15-bill package would, among other things, regulate pharmacy benefit managers that run prescription drug coverage for insurers and employers, and ban the “middlemen” PBMs from profiting by charging a health plan and their enrollees more than what is paid to the dispensing pharmacy. Three managers dominate the U.S. market: CVS Health’s Caremark business, UnitedHealth’s OptumRx and Cigna’s recently acquired Express Scripts.

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Other bills would cap insulin co-pays at $50 for a 30-day supply, require insurers to count all drug rebates received for a medication toward a family’s deductible or maximum out-of-pocket costs, and limit drugmakers’ ability to give gifts to doctors.

House Speaker Jason Wentworth, a Farwell Republican, said “existing problems with our rigged health care system are magnified” in the coronavirus pandemic. “Those problems have always been there. It is well past time to fix this problem and make health care work for Michigan families.”

The legislation has support from some Democrats in the GOP-controlled House. Wentworth, who anticipates opposition within the insurance industry, said additional health care measures will be introduced in the future.

One bill addresses the tendency for chemo pills to cost patients much more out of pocket than if they get chemo by needle. It would require equal insurance coverage.

“This legislation was initially introduced 15 years ago and this step signals the House’s awareness of the need to get this passed for Michiganders fighting cancer,” said Andrew Schepers, Michigan government relations director for the American Cancer Society Cancer Action Network.

Other bills would mandate more transparency about drug prices and hospital charges, allow consumers to use telehealth to renew their contact lenses, expand the scope of practice for nurse anesthetists and stop insurers from removing medicines from their list of offerings during a plan year.

The Michigan Association of Health Plans said it supports some bills but is concerned that others would result in higher premiums and inhibit competition.

“Michigan health insurance premiums are already growing at an annual rate of 4.61%, reflective of health care cost increases and a lack of competition for commercial health insurance,” said executive director Dominick Pallone. “We will work with the Legislature to address concerns, particularly in the area of growing pharmaceutical costs, as part of our mission to create affordable, accessible and quality health care for all Michigan citizens.”

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