Assembly Bill 173 introduces comprehensive regulatory reforms for pharmacy benefit managers (PBMs) in Wisconsin, emphasizing fair interactions with pharmacies and pharmacists. The bill requires PBMs to 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 lower reimbursements, such as claim-processing or performance-based fees, and ensures that pharmacies can join PBM networks under the same terms as their peers. Furthermore, the bill protects pharmacies from penalties for informing patients about drug costs and enhances transparency by mandating PBMs disclose financial details to health benefit plan sponsors.

The legislation also includes specific protections for 340B covered entities, preventing PBMs from discriminating against them regarding reimbursement rates and operational requirements. It prohibits actions like assessing fees after claims are paid and restricts access to pharmacy networks based solely on participation in the 340B program. Additionally, the bill mandates that health insurance policies apply payments for brand name drugs towards cost-sharing and out-of-pocket maximums, while safeguarding pharmacies and pharmacists from retaliation for reporting violations. The bill amends existing statutes to incorporate new compliance requirements, specifically through the insertion of section 632.862 into the legal framework.

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