Assembly Bill 173 introduces comprehensive regulatory reforms for pharmacy benefit managers (PBMs) in Wisconsin, aiming to enhance the relationship between PBMs, 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 rate, in addition to the reimbursement for the pharmaceutical product. It prohibits PBMs from imposing fees that would diminish pharmacy compensation and restricts certification or accreditation requirements beyond federal 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 networks and prohibits varying copayment obligations based on network participation.

Furthermore, the bill establishes protections for 340B covered entities, preventing PBMs from discriminating against them in reimbursement rates and imposing additional requirements. It prohibits PBMs from assessing fees after claims are paid, restricting access to pharmacy networks based on 340B participation, and requiring 340B entities to contract with specific pharmacies. The bill also protects pharmacies and pharmacists from retaliatory actions by PBMs for reporting violations, allowing them to seek injunctive relief and recover attorney fees if they prevail. Additionally, it amends existing statutes to include new compliance requirements for health care coverage plans, specifically adding section 632.862. Overall, Assembly Bill 173 aims to improve fairness and transparency in pharmacy benefit management, ensuring better compensation for pharmacies and more accessible options for patients.

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