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 rate paid 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 regarding drug formularies and reimbursement practices, including the obligation to provide advanced notice of formulary changes and to make formulary information available prior to enrollment. It establishes that PBMs must reimburse pharmacies at the same rates within a preferred network and prohibits discriminatory practices against 340B entities. The bill also protects 340B covered entities from various restrictions and penalties, such as assessing fees after claims have been paid and restricting access to pharmacy networks based on 340B participation. Furthermore, it prohibits retaliatory actions by PBMs against pharmacies or pharmacists who report violations, allowing them to seek injunctive relief and recover attorney fees if they prevail. Overall, Senate Bill 203 seeks to create a more equitable framework for pharmacy benefit management in Wisconsin.

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