Assembly Bill 173 introduces comprehensive regulatory reforms for pharmacy benefit managers (PBMs) in Wisconsin, focusing on their relationships with pharmacies and pharmacists. The bill mandates that PBMs pay a professional dispensing fee to pharmacies that is at least equal to the state’s Medical Assistance program rates. 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 standards. Additionally, the bill ensures that participants in pharmacy benefits plans can access any licensed pharmacy that agrees to the same terms as those in the PBM's networks, while also preventing PBMs from incentivizing beneficiaries to use specific pharmacies.

The legislation further enhances transparency and fairness in drug formularies and reimbursement practices by requiring PBMs to disclose maximum allowable cost lists and allowing pharmacies to appeal reimbursement disputes. It establishes fiduciary duties for PBMs towards health benefit plan sponsors, including annual profit disclosures related to pharmacy services. The bill specifically protects 340B covered entities from discriminatory practices, ensuring equitable reimbursement rates and preventing additional restrictions. It also prohibits PBMs from retaliating against pharmacies or pharmacists who report violations, allowing them to seek injunctive relief in court. Overall, Assembly Bill 173 aims to improve accountability and operational standards for PBMs, benefiting both pharmacies and patients in Wisconsin.

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