Amendment SSA1-AB68

AB68-SSA1,1358,11 (a) “Administrative service” means any of the following:

AB68-SSA1,1358,12 1. Assisting with claims.

AB68-SSA1,1358,13 2. Assisting with audits.

AB68-SSA1,1358,14 3. Providing centralized payment.

AB68-SSA1,1358,15 4. Performing certification in a specialized care program.

AB68-SSA1,1358,16 5. Providing compliance support.

AB68-SSA1,1358,17 6. Setting flat fees for generic drugs.

AB68-SSA1,1358,18 7. Assisting with store layout.

AB68-SSA1,1358,19 8. Managing inventory.

AB68-SSA1,1358,20 9. Providing marketing support.

AB68-SSA1,1358,21 10. Providing management and analysis of payment and drug dispensing data.

AB68-SSA1,1358,22 11. Providing resources for retail cash cards.

AB68-SSA1,1358,25 (b) “Independent pharmacy" means a pharmacy operating in this state that is licensed under s. 450.06 or 450.065 and is under common ownership with no more than 2 other pharmacies.

AB68-SSA1,1359,1 (c) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

AB68-SSA1,1359,3 (d) “Pharmacy services administrative organization” means an entity operating in this state that does all of the following:

AB68-SSA1,1359,5 1. Contracts with an independent pharmacy to conduct business on the pharmacy's behalf with a 3rd-party payer.

AB68-SSA1,1359,8 2. Provides at least one administrative service to an independent pharmacy and negotiates and enters into a contract with a 3rd-party payer or pharmacy benefit manager on behalf of the pharmacy.

AB68-SSA1,1359,11 (e) “Third-party payer” means an entity, including a plan sponsor, health maintenance organization, or insurer, operating in this state that pays or insures health, medical, or prescription drug expenses on behalf of beneficiaries.

AB68-SSA1,1359,16 (2) Licensure. (a) A person may not operate as a pharmacy services administrative organization in this state without a pharmacy services administrative organization license. In order to obtain a license, a person shall apply to the commissioner in the form and manner prescribed by the commissioner. The application shall include all of the following:

AB68-SSA1,1359,18 1. The name, address, telephone number, and federal employer identification number of the applicant.

AB68-SSA1,1359,20 2. The name, business address, and telephone number of a contact person for the applicant.

AB68-SSA1,1359,21 3. The fee under s. 601.31 (1) (nw).

AB68-SSA1,1359,22 4. Evidence of financial responsibility of at least $1,000,000.

AB68-SSA1,1359,23 5. Any other information required by the commissioner.

AB68-SSA1,1359,25 (b) The term of a license issued under par. (a) shall be 2 years from the date of issuance.

AB68-SSA1,1360,4 (3) Disclosure to the commissioner. (a) A pharmacy services administrative organization shall disclose to the commissioner the extent of any ownership or control of the pharmacy services administrative organization by an entity that does any of the following:

AB68-SSA1,1360,5 1. Provides pharmacy services.

AB68-SSA1,1360,6 2. Provides prescription drug or device services.

AB68-SSA1,1360,8 3. Manufactures, sells, or distributes prescription drugs, biologicals, or medical devices.

AB68-SSA1,1360,11 (b) A pharmacy services administrative organization shall notify the commissioner in writing within 5 days of any material change in its ownership or control relating to an entity described in par. (a).

AB68-SSA1,1360,12 (4) Rules. The commissioner may promulgate rules to implement this section.

AB68-SSA1,2998 Section 2998. 632.865 (2m) of the statutes is created to read:

AB68-SSA1,1360,17 632.865 (2m) Fiduciary duty and disclosures to health benefit plan sponsors. (a) A pharmacy benefit manager owes a fiduciary duty to the health benefit plan sponsor to act according to the health benefit plan sponsor's instructions and in the best interests of the health benefit plan sponsor.

AB68-SSA1,1360,20 (b) A pharmacy benefit manager shall annually provide, no later than the date and using the method prescribed by the commissioner by rule, the health benefit plan sponsor all of the following information from the previous calendar year:

AB68-SSA1,1360,22 1. The indirect profit received by the pharmacy benefit manager from owning any interest in a pharmacy or service provider.

AB68-SSA1,1360,24 2. Any payment made by the pharmacy benefit manager to a consultant or broker who works on behalf of the health benefit plan sponsor.

AB68-SSA1,1361,4 3. From the amounts received from all drug manufacturers, the amounts retained by the pharmacy benefit manager, and not passed through to the health benefit plan sponsor, that are related to the health benefit plan sponsor's claims or bona fide service fees.

AB68-SSA1,1361,9 4. The amounts, including pharmacy access and audit recovery fees, received from all pharmacies that are in the pharmacy benefit manager's network or have a contract to be in the network and, from these amounts, the amount retained by the pharmacy benefit manager and not passed through to the health benefit plan sponsor.

AB68-SSA1,2999 Section 2999. 632.8655 of the statutes is created to read:

AB68-SSA1,1361,11 632.8655 Hospital drug cost reporting. (1) Definitions. In this section:

AB68-SSA1,1361,13 (a) “Brand-name drug” means a prescription drug approved under 21 USC 355 (b) or 42 USC 262.

AB68-SSA1,1361,15 (b) “Covered hospital” means an entity described in 42 USC 256b (a) (4) (L) to (N) that participates in the federal drug pricing program under 42 USC 256b.

AB68-SSA1,1361,16 (c) “Generic drug” means a prescription drug approved under 21 USC 355 (j).

AB68-SSA1,1361,20 (d) “Margin” means, for a covered hospital, the difference between the net cost of a brand-name drug or generic drug covered under the federal drug pricing program under 42 USC 256b and the net payment by the covered hospital for that brand-name drug or generic drug.

AB68-SSA1,1361,22 (e) “Net payment” means the amount paid for a brand-name drug or generic drug after all discounts and rebates have been applied.

AB68-SSA1,1362,2 (2) Hospital margin spending. By March 1 annually, each covered hospital operating in this state shall report to the commissioner the per unit margin for each drug covered under the federal drug pricing program under 42 USC 256b dispensed in the previous year multiplied by the number of units dispensed at that margin and how the margin revenue was used.

AB68-SSA1,1362,8 (3) Public reporting. The commissioner shall publicly post covered hospital documentation of how each hospital spends the margin revenue. The commissioner shall analyze data collected under this section and publish annually a report including an analysis on hospital-specific margins and how that revenue is spent or allocated on a hospital-specific basis. The commissioner shall keep any trade secret or proprietary information confidential.

AB68-SSA1,3000 Section 3000. 632.8665 of the statutes is created to read:

AB68-SSA1,1362,11 632.8665 Prescription drug cost reporting. (1) Definitions. In this section:

AB68-SSA1,1362,13 (a) “Brand-name drug” means a prescription drug approved under 21 USC 355 (b) or 42 USC 262.

AB68-SSA1,1362,14 (b) “Generic drug” means a prescription drug approved under 21 USC 355 (j).

AB68-SSA1,1362,17 (c) “Manufacturer” has the meaning given in s. 450.01 (12). “Manufacturer” does not include an entity that is engaged only in the dispensing, as defined in s. 450.01 (7), of a brand-name drug or generic drug.

AB68-SSA1,1362,21 (d) “Manufacturer-sponsored assistance program” means a program offered by a manufacturer or an intermediary under contract with a manufacturer through which a brand-name drug or generic drug is provided to a patient at no charge or at a discount.

AB68-SSA1,1362,22 (e) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

AB68-SSA1,1363,2 (f) “Pharmacy services administrative organization” means an entity that provides contracting and other administrative services to a pharmacy to assist the pharmacy in interactions with a 3rd-party payer, pharmacy benefit manager, wholesale drug distributor, or other entity.

AB68-SSA1,1363,6 (g) “Wholesale acquisition cost” means the most recently reported manufacturer list or catalog price for a brand-name drug or generic drug available to wholesalers or direct purchasers in the United States, before application of discounts, rebates, or reductions in price.

AB68-SSA1,1363,12 (2) Price increase or introduction notice; justification report. (a) A manufacturer shall notify the commissioner if it is increasing the wholesale acquisition cost of a brand-name drug on the market in this state by more than 10 percent or by more than $10,000 during any 12-month period or if it intends to introduce to market in this state a brand-name drug that has an annual wholesale acquisition cost of $30,000 or more.

AB68-SSA1,1363,16 (b) A manufacturer shall notify the commissioner if it is increasing the wholesale acquisition cost of a generic drug by more than 25 percent or by more than $300 during any 12-month period or if it intends to introduce to market a generic drug that has an annual wholesale acquisition cost of $3,000 or more.

AB68-SSA1,1363,22 (c) The manufacturer shall provide the notice under par. (a) or (b) in writing at least 30 days before the planned effective date of the cost increase or drug introduction with a justification that includes all documents and research related to the manufacturer's selection of the cost increase or introduction price and a description of life cycle management, market competition and context, and estimated value or cost-effectiveness of the product.

AB68-SSA1,1364,2 (3) Net prices paid by pharmacy benefit managers. By March 1 annually, the manufacturer shall report to the commissioner the value of price concessions, expressed as a percentage of the wholesale acquisition cost, provided to each pharmacy benefit manager for each drug sold in this state.

AB68-SSA1,1364,7 (4) Rebates and price concessions. By March 1 annually, each pharmacy benefit manager shall report to the commissioner the amount received from manufacturers as drug rebates and the value of price concessions, expressed as a percentage of the wholesale acquisition cost, provided by manufacturers for each drug.

AB68-SSA1,1364,11 (5) Manufacturer-sponsored assistance programs. By March 1 annually, each manufacturer shall provide the commissioner with a description of each manufacturer-sponsored patient assistance program in effect during the previous year that includes all of the following:

AB68-SSA1,1364,12 (a) The terms of the programs.

AB68-SSA1,1364,13 (b) The number of prescriptions provided to state residents under the program.

AB68-SSA1,1364,15 (c) The total market value of assistance provided to residents of this state under the program.

AB68-SSA1,1364,18 (6) Pharmacy services administrative organizations. By March 1 annually, each pharmacy services administrative organization shall report to the commissioner all of the following information:

AB68-SSA1,1364,20 (a) The negotiated reimbursement rate of the 25 prescription drugs with the highest reimbursement rates during the previous year.

AB68-SSA1,1364,22 (b) The 25 prescription drugs with the highest year-to-year change in reimbursement rate for the previous year.

AB68-SSA1,1364,23 (c) The schedule of fees charged by the organization to pharmacies.

AB68-SSA1,1365,4 (7) Certification and penalties for noncompliance. Each manufacturer and pharmacy services administrative organization that is required to report under this section shall certify each report as accurate under the penalty of perjury. A manufacturer or pharmacy services administrative organization that fails to submit a report required under this section is subject to a forfeiture of no more than $10,000 each day the report is overdue.

AB68-SSA1,1365,7 (8) Hearing and public reporting. (a) The commissioner shall publicly post manufacturer price justification documents. The commissioner shall keep any trade secret or proprietary information confidential.

AB68-SSA1,1365,13 (b) The commissioner shall analyze data collected under this section and publish annually a report on emerging trends in prescription prices and price increases and shall annually conduct a public hearing based on the analysis under this paragraph. The report under this paragraph shall include analysis of manufacturer prices and price increases and analysis of how pharmacy benefit manager discounts and net costs compare to retail prices paid by patients.

AB68-SSA1,3001 Section 3001. 632.868 of the statutes is created to read:

AB68-SSA1,1365,15 632.868 Insulin safety net programs. (1) Definitions. In this section:

AB68-SSA1,1365,17 (a) “Manufacturer" means a person engaged in the manufacturing of insulin that is self-administered on an outpatient basis.

AB68-SSA1,1365,18 (b) “Navigator" has the meaning given in s. 628.90 (3).

AB68-SSA1,1365,20 (c) “Patient assistance program” means a program established by a manufacturer under sub. (3) (a).

AB68-SSA1,1365,21 (d) “Pharmacy" means an entity licensed under s. 450.06 or 450.065.

AB68-SSA1,1365,24 (e) “Urgent need of insulin" means having less than a 7-day supply of insulin readily available for use and needing insulin in order to avoid the likelihood of suffering a significant health consequence.

AB68-SSA1,1366,2 (f) “Urgent need safety net program” means a program established by a manufacturer under sub. (2) (a).

AB68-SSA1,1366,6 (2) Urgent need safety net program. (a) Establishment of program. No later than July 1, 2022, each manufacturer shall establish an urgent need safety net program to make insulin available in accordance with this subsection to individuals who meet the eligibility requirements under par. (b).

AB68-SSA1,1366,8 (b) Eligible individual. An individual shall be eligible to receive insulin under an urgent need safety net program if all of the following conditions are met:

AB68-SSA1,1366,9 1. The individual is in urgent need of insulin.

AB68-SSA1,1366,10 2. The individual is a resident of this state.

AB68-SSA1,1366,11 3. The individual is not receiving public assistance under ch. 49.

AB68-SSA1,1366,16 4. The individual is not enrolled in prescription drug coverage through an individual or group health plan that limits the total cost sharing amount, including copayments, deductibles, and coinsurance, that an enrollee is required to pay for a 30-day supply of insulin to no more than $75, regardless of the type or amount of insulin prescribed.

AB68-SSA1,1366,18 5. The individual has not received insulin under an urgent need safety net program within the previous 12 months, except as allowed under par. (d).

AB68-SSA1,1366,22 (c) Provision of insulin under an urgent need safety net program. 1. In order to receive insulin under an urgent need safety net program, an individual who meets the eligibility requirements under par. (b) shall provide a pharmacy with all of the following:

AB68-SSA1,1367,2 a. A completed application, on a form prescribed by the commissioner that shall include an attestation by the individual, or the individual's parent or legal guardian if the individual is under the age of 18, that the individual meets all of the eligibility requirements under par. (b).