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 mandates that PBMs pay a professional dispensing fee to pharmacies that is at least equal to the fee 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 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 penalizing individuals for using specific pharmacies.

The legislation further introduces protections for 340B covered entities, prohibiting PBMs from imposing fees or adjustments after claims have been paid, restricting access to pharmacy networks based on participation in the 340B program, and preventing additional charges on patients obtaining 340B drugs. It also establishes protections against retaliation for pharmacies and pharmacists who report PBM violations, allowing them to seek injunctive relief in court and recover attorney fees if they prevail. The bill includes new legal language to ensure compliance with health care coverage regulations and aims to promote fairness and accountability within the pharmacy benefit management sector.

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