SB 737

This bill makes several changes to the regulation of pharmacy benefit

managers and their interactions with pharmacies and pharmacists. Under current

law, pharmacy benefit managers are generally required to be licensed as a pharmacy

benefit manager or an employee benefit plan administrator by the commissioner of

insurance. A pharmacy benefit manager is an entity that contracts to administer or

manage prescription drug benefits on behalf of an insurer, a cooperative, or another

entity that provides prescription drug benefits to Wisconsin residents. Major

provisions of the bill are summarized below.

Pharmacy benefit manager regulation

The bill requires a pharmacy benefit manager to pay a pharmacy or pharmacist

a professional dispensing fee at a rate not less than is paid by the state under the

Medical Assistance program for each pharmaceutical product that the pharmacy or

pharmacist dispenses to an individual. The professional dispensing fee is required

to be paid in addition to the amount the pharmacy benefit manager reimburses the

pharmacy or pharmacist for the cost of the pharmaceutical product that the

pharmacy or pharmacist dispenses. The Medical Assistance program is a joint state

and federal program that provides health services to individuals who have limited

financial resources.

The bill prohibits a pharmacy benefit manager from assessing, charging, or

collecting from a pharmacy or pharmacist any form of remuneration that passes from

the pharmacy or pharmacist to the pharmacy benefit manager including

claim-processing fees, performance-based fees, network-participation fees, or

accreditation fees.

Further, under the bill, a pharmacy benefit manager may not use any

certification or accreditation requirement as a determinant of pharmacy network

participation that is inconsistent with, more stringent than, or in addition to the

federal requirements for licensure as a pharmacy and the requirements for licensure

as a pharmacy provided under state law.

The bill requires a pharmacy benefit manager to allow a participant or

beneficiary of a pharmacy benefits plan or program that the pharmacy benefit

manager serves to use any pharmacy or pharmacist in this state that is licensed to

dispense the pharmaceutical product that the participant or beneficiary seeks to

obtain if the pharmacy or pharmacist accepts the same terms and conditions that the

pharmacy benefit manager establishes for at least one of the networks of pharmacies

or pharmacists that the pharmacy benefit manager has established to serve

individuals in the state. A pharmacy benefit manager may establish a preferred

network of pharmacies or pharmacists and a nonpreferred network of pharmacies

or pharmacists, however, under the bill, a pharmacy benefit manager may not

prohibit a pharmacy or pharmacist from participating in either type of network

provided that the pharmacy or pharmacist is licensed by this state and the federal