Assembly Bill 173 seeks to strengthen the regulation of pharmacy benefit managers (PBMs) in Wisconsin by establishing new requirements for their interactions with pharmacies and pharmacists. The bill mandates that PBMs pay a professional dispensing fee to pharmacies that is at least equal to the amount paid by the state under the Medical Assistance program, in addition to the reimbursement for the pharmaceutical product. It prohibits PBMs from charging pharmacies any remuneration, such as claim-processing or performance-based fees, and limits their ability to impose certification requirements beyond federal or state standards. The bill also ensures that participants in pharmacy benefits plans can access any licensed pharmacy that agrees to the same terms as those in the PBM's established networks.

Furthermore, the bill introduces provisions to protect 340B covered entities and their contracted pharmacies from various restrictions and penalties imposed by PBMs. It prohibits actions such as assessing fees or chargebacks after claims have been paid and restricts access to pharmacy networks based solely on participation in the 340B program. The bill also protects pharmacies and pharmacists from retaliation by PBMs for reporting violations or exercising their rights, allowing them to seek injunctive relief and recover attorney fees if they prevail. Additionally, the bill amends existing statutes to include new compliance requirements for health care coverage plans, specifically adding section 632.862 to the list of applicable statutes.

Statutes affected:
Bill Text: 40.51(8), 40.51, 40.51(8m)