Senate Bill 203 aims to strengthen the regulation of pharmacy benefit managers (PBMs) in Wisconsin by enhancing their accountability and transparency in dealings with pharmacies and pharmacists. The bill requires PBMs to pay a professional dispensing fee to pharmacies that is at least equal to the amount paid by the state under the Medical Assistance program. It prohibits PBMs from charging pharmacies any remuneration, such as claim-processing or performance-based fees, and limits their certification requirements to those that meet 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 penalizing individuals for choosing specific pharmacies.

The legislation introduces new requirements for PBMs concerning drug formularies, maximum allowable cost lists, and pharmacy audits. It mandates that PBMs provide detailed information on their maximum allowable cost lists and allows pharmacies to appeal reimbursement disputes. The bill also establishes fiduciary duties for PBMs to health benefit plan sponsors, requires annual disclosures of financial relationships, and prohibits discriminatory practices against 340B entities. Furthermore, it protects 340B covered entities from various restrictions, ensures that health insurance policies apply amounts paid for brand name drugs towards cost-sharing, and safeguards pharmacies and pharmacists from retaliation for reporting violations. The bill amends existing statutes to include new compliance requirements, specifically adding section 632.862 to the applicable laws for state health care coverage plans.

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