This is the preview version of the Wisconsin State Legislature site.
Please see http://docs.legis.wisconsin.gov for the production version.
AB50-ASA2-AA8,167,117(a) Covered entity means an entity described in 42 USC 256b (a) (4) (A), (D),
8(E), (J), or (N) that participates in the federal drug pricing program under 42 USC
9256b, a pharmacy of the entity, or a pharmacy contracted with the entity to
10dispense drugs purchased through the federal drug pricing program under 42 USC
11256b.
AB50-ASA2-AA8,167,1212(b) Pharmacy benefit manager has the meaning given in s. 632.865 (1) (c).
AB50-ASA2-AA8,167,1413(2) No person, including a pharmacy benefit manager or 3rd-party payer, may
14do any of the following:
AB50-ASA2-AA8,167,1815(a) Reimburse a covered entity for a drug that is subject to an agreement
16under 42 USC 256b at a rate lower than that paid for the same drug to pharmacies
17that are not covered entities and have a similar prescription volume to that of the
18covered entity.
AB50-ASA2-AA8,167,2119(b) Assess a covered entity any fee, charge back, or other adjustment on the
20basis of the covered entitys participation in the federal drug pricing program under
2142 USC 256b.
AB50-ASA2-AA8,168,222(3) The commissioner may promulgate rules to implement this section and to

1establish minimum reimbursement rates for covered entities and any other entity
2described under 42 USC 256b (a) (4)..
AB50-ASA2-AA8,168,3360. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,168,44Section 307. 601.31 (1) (nw) of the statutes is created to read:
AB50-ASA2-AA8,168,75601.31 (1) (nw) For issuing or renewing a license as a pharmacy services
6administrative organization under s. 632.864, an amount to be set by the
7commissioner by rule.
AB50-ASA2-AA8,3088Section 308. 632.864 of the statutes is created to read:
AB50-ASA2-AA8,168,109632.864 Pharmacy services administrative organizations. (1)
10Definitions. In this section:
AB50-ASA2-AA8,168,1111(a) Administrative service means any of the following:
AB50-ASA2-AA8,168,12121. Assisting with claims.
AB50-ASA2-AA8,168,13132. Assisting with audits.
AB50-ASA2-AA8,168,14143. Providing centralized payment.
AB50-ASA2-AA8,168,15154. Performing certification in a specialized care program.
AB50-ASA2-AA8,168,16165. Providing compliance support.
AB50-ASA2-AA8,168,17176. Setting flat fees for generic drugs.
AB50-ASA2-AA8,168,18187. Assisting with store layout.
AB50-ASA2-AA8,168,19198. Managing inventory.
AB50-ASA2-AA8,168,20209. Providing marketing support.
AB50-ASA2-AA8,168,222110. Providing management and analysis of payment and drug dispensing
22data.
AB50-ASA2-AA8,168,232311. Providing resources for retail cash cards.
AB50-ASA2-AA8,169,3
1(b) Independent pharmacy means a pharmacy operating in this state that is
2licensed under s. 450.06 or 450.065 and is under common ownership with no more
3than 2 other pharmacies.
AB50-ASA2-AA8,169,44(c) Pharmacy benefit manager has the meaning given in s. 632.865 (1) (c).
AB50-ASA2-AA8,169,65(d) Pharmacy services administrative organization means an entity
6operating in this state that does all of the following:
AB50-ASA2-AA8,169,871. Contracts with an independent pharmacy to conduct business with a 3rd-
8party payer on the independent pharmacys behalf.
AB50-ASA2-AA8,169,1192. Provides at least one administrative service to an independent pharmacy
10and negotiates and enters into a contract with a 3rd-party payer or pharmacy
11benefit manager on behalf of the independent pharmacy.
AB50-ASA2-AA8,169,1412(e) Third-party payer means an entity, including a plan sponsor, health
13maintenance organization, or insurer, operating in this state that pays or insures
14health, medical, or prescription drug expenses on behalf of beneficiaries.
AB50-ASA2-AA8,169,2115(2) Licensure. (a) Beginning on the first day of the 12th month beginning
16after the effective date of this paragraph .... [LRB inserts date], no person may
17operate as a pharmacy services administrative organization without being licensed
18by the commissioner as a pharmacy services administrative organization under this
19subsection. In order to obtain a license under this paragraph, the person shall
20apply to the commissioner in the form and manner prescribed by the commissioner.
21The application for licensure under this paragraph shall include all of the following:
AB50-ASA2-AA8,169,23221. The name, address, telephone number, and federal employer identification
23number of the applicant.
AB50-ASA2-AA8,170,2
12. The name, business address, and telephone number of a contact person for
2the applicant.
AB50-ASA2-AA8,170,333. The fee under s. 601.31 (1) (nw).
AB50-ASA2-AA8,170,444. Evidence of financial responsibility of at least $1,000,000.
AB50-ASA2-AA8,170,555. Any other information required by the commissioner.
AB50-ASA2-AA8,170,76(b) The term of a license issued under par. (a) shall be 2 years from the date of
7issuance.
AB50-ASA2-AA8,170,128(c) A license issued under par. (a) may be renewed. Renewal applications shall
9be submitted to the commissioner on a form provided by the commissioner and shall
10include all the items described in par. (a) 1. to 5. A renewal application under this
11paragraph may not be submitted more than 90 days prior to the end of the term of
12the license being renewed.
AB50-ASA2-AA8,170,1613(3) Disclosure to the commissioner. (a) A pharmacy services
14administrative organization licensed under sub. (2) shall disclose to the
15commissioner the extent of any ownership or control of the pharmacy services
16administrative organization by an entity that does any of the following:
AB50-ASA2-AA8,170,17171. Provides pharmacy services.
AB50-ASA2-AA8,170,18182. Provides prescription drug or device services.
AB50-ASA2-AA8,170,20193. Manufactures, sells, or distributes prescription drugs, biologicals, or
20medical devices.
AB50-ASA2-AA8,170,2321(b) A pharmacy services administrative organization licensed under sub. (2)
22shall notify the commissioner in writing within 5 days of any material change in its
23ownership or control relating to an entity described in par. (a).
AB50-ASA2-AA8,171,2
1(4) Rules. The commissioner may promulgate rules to implement this
2section..
AB50-ASA2-AA8,171,3361. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,171,44Section 309. 46.48 (33) of the statutes is created to read:
AB50-ASA2-AA8,171,7546.48 (33) Diaper bank grants. The department may distribute not more
6than $500,000 in each fiscal year as grants to diaper banks to provide diapers to
7families in need.
AB50-ASA2-AA8,92198Section 9219. Fiscal changes; Health Services.
AB50-ASA2-AA8,171,139(1) Diaper bank grants. In the schedule under s. 20.005 (3) for the
10appropriation to the department of health services under s. 20.435 (1) (b), the dollar
11amount for fiscal year 2025-26 is increased by $500,000 and the dollar amount for
12fiscal year 2026-27 is increased by $500,000 to provide grants to diaper banks
13under s. 46.48 (33)..
AB50-ASA2-AA8,171,141462. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,171,1515Section 310. 601.31 (1) (nv) of the statutes is created to read:
AB50-ASA2-AA8,171,1716601.31 (1) (nv) For issuing or renewing a license as a pharmaceutical
17representative under s. 632.863, an amount to be set by the commissioner by rule.
AB50-ASA2-AA8,31118Section 311. 632.863 of the statutes is created to read:
AB50-ASA2-AA8,171,2019632.863 Pharmaceutical representatives. (1) Definitions. In this
20section:
AB50-ASA2-AA8,171,2321(a) Health care professional means a physician or other health care
22practitioner who is licensed to provide health care services or to prescribe
23pharmaceutical or biologic products.
AB50-ASA2-AA8,172,2
1(b) Pharmaceutical means a medication that may legally be dispensed only
2with a valid prescription from a health care professional.
AB50-ASA2-AA8,172,53(c) Pharmaceutical representative means an individual who markets or
4promotes pharmaceuticals to health care professionals on behalf of a
5pharmaceutical manufacturer for compensation.
AB50-ASA2-AA8,172,136(2) Licensure. Beginning on the first day of the 12th month beginning after
7the effective date of this subsection .... [LRB inserts date], no individual may act as
8a pharmaceutical representative in this state without being licensed by the
9commissioner as a pharmaceutical representative under this subsection. In order
10to obtain a license under this subsection, the individual shall apply to the
11commissioner in the form and manner prescribed by the commissioner and shall
12pay the fee under s. 601.31 (1) (nv). The term of a license issued under this
13subsection is one year, and the license is renewable.
AB50-ASA2-AA8,172,1614(3) Display of license. A pharmaceutical representative licensed under sub.
15(2) shall display the pharmaceutical representatives license during each visit with
16a health care professional.
AB50-ASA2-AA8,172,2017(4) Enforcement. (a) Any individual who violates this section or any rules
18promulgated under this section shall be fined not less than $1,000 nor more than
19$3,000 for each offense. Each day of continued violation constitutes a separate
20offense.
AB50-ASA2-AA8,173,221(b) The commissioner may suspend or revoke the license of a pharmaceutical
22representative who violates this section or any rules promulgated under this
23section. A suspended or revoked license under this paragraph may not be

1reinstated until the pharmaceutical representative remedies all violations related
2to the suspension or revocation and pays all assessed penalties and fees.
AB50-ASA2-AA8,173,53(5) Rules. The commissioner shall promulgate rules to implement this
4section, including rules that require pharmaceutical representatives to complete
5continuing educational coursework as a condition of licensure..
AB50-ASA2-AA8,173,6663. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,173,77Section 312. 601.31 (1) (mv) of the statutes is created to read:
AB50-ASA2-AA8,173,108601.31 (1) (mv) For initial issuance or renewal of a license as a pharmacy
9benefit management broker or consultant under s. 628.495, amounts set by the
10commissioner by rule.
AB50-ASA2-AA8,31311Section 313. 628.495 of the statutes is created to read:
AB50-ASA2-AA8,173,1412628.495 Pharmacy benefit management broker and consultant
13licenses. (1) Definition. In this section, pharmacy benefit manager has the
14meaning given in s. 632.865 (1) (c).
AB50-ASA2-AA8,173,1915(2) License required. Beginning on the first day of the 12th month
16beginning after the effective date of this subsection .... [LRB inserts date], no
17individual may act as a pharmacy benefit management broker or consultant and no
18individual may act to procure the services of a pharmacy benefit manager on behalf
19of a client without being licensed by the commissioner under this section.
AB50-ASA2-AA8,173,2220(3) Rules. The commissioner may promulgate rules to establish criteria and
21procedures for initial licensure and renewal of licensure and to implement licensure
22under this section..
AB50-ASA2-AA8,173,232364. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,174,1
1Section 314. 632.865 (2m) of the statutes is created to read:
AB50-ASA2-AA8,174,52632.865 (2m) Fiduciary duty and disclosures to health benefit plan
3sponsors. (a) A pharmacy benefit manager owes a fiduciary duty to the health
4benefit plan sponsor to act according to the health benefit plan sponsors
5instructions and in the best interests of the health benefit plan sponsor.
AB50-ASA2-AA8,174,96(b) A pharmacy benefit manager shall annually provide, no later than the
7date and using the method prescribed by the commissioner by rule, the health
8benefit plan sponsor all of the following information from the previous calendar
9year:
AB50-ASA2-AA8,174,11101. The indirect profit received by the pharmacy benefit manager from owning
11any interest in a pharmacy or service provider.
AB50-ASA2-AA8,174,13122. Any payment made by the pharmacy benefit manager to a consultant or
13broker who works on behalf of the health benefit plan sponsor.
AB50-ASA2-AA8,174,17143. From the amounts received from all drug manufacturers, the amounts
15retained by the pharmacy benefit manager, and not passed through to the health
16benefit plan sponsor, that are related to the health benefit plan sponsors claims or
17bona fide service fees.
AB50-ASA2-AA8,174,22184. The amounts, including pharmacy access and audit recovery fees, received
19from all pharmacies that are in the pharmacy benefit managers network or have a
20contract to be in the network and, from these amounts, the amount retained by the
21pharmacy benefit manager and not passed through to the health benefit plan
22sponsor..
AB50-ASA2-AA8,174,232365. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,175,1
1Section 315. 609.74 of the statutes is created to read:
AB50-ASA2-AA8,175,32609.74 Coverage of infertility services. Defined network plans and
3preferred provider plans are subject to s. 632.895 (15m).
AB50-ASA2-AA8,3164Section 316. 632.895 (15m) of the statutes is created to read:
AB50-ASA2-AA8,175,55632.895 (15m) Coverage of infertility services. (a) In this subsection:
AB50-ASA2-AA8,175,1161. Diagnosis of and treatment for infertility means any recommended
7procedure or medication to treat infertility at the direction of a physician that is
8consistent with established, published, or approved medical practices or
9professional guidelines from the American College of Obstetricians and
10Gynecologists, or its successor organization, or the American Society for
11Reproductive Medicine, or its successor organization.
AB50-ASA2-AA8,175,13122. Infertility means a disease, condition, or status characterized by any of
13the following:
AB50-ASA2-AA8,175,1814a. The failure to establish a pregnancy or carry a pregnancy to a live birth
15after regular, unprotected sexual intercourse for, if the woman is under the age of
1635, no longer than 12 months or, if the woman is 35 years of age or older, no longer
17than 6 months, including any time during those 12 months or 6 months that the
18woman has a pregnancy that results in a miscarriage.
AB50-ASA2-AA8,175,2019b. An individuals inability to reproduce either as a single individual or with a
20partner without medical intervention.
AB50-ASA2-AA8,175,2221c. A physicians findings based on a patients medical, sexual, and
22reproductive history, age, physical findings, or diagnostic testing.
AB50-ASA2-AA8,176,2
13. Self-insured health plan means a self-insured health plan of the state or
2a county, city, village, town, or school district.
AB50-ASA2-AA8,176,934. Standard fertility preservation service means a procedure that is
4consistent with established medical practices or professional guidelines published
5by the American Society for Reproductive Medicine, or its successor organization, or
6the American Society of Clinical Oncology, or its successor organization, for a
7person who has a medical condition or is expected to undergo medication therapy,
8surgery, radiation, chemotherapy, or other medical treatment that is recognized by
9medical professionals to cause a risk of impairment to fertility.
AB50-ASA2-AA8,176,1710(b) Subject to pars. (c) to (e), every disability insurance policy and self-insured
11health plan that provides coverage for medical or hospital expenses shall cover
12diagnosis of and treatment for infertility and standard fertility preservation
13services. Coverage required under this paragraph includes at least 4 completed
14oocyte retrievals with unlimited embryo transfers, in accordance with the
15guidelines of the American Society for Reproductive Medicine, or its successor
16organization, and single embryo transfer when recommended and medically
17appropriate.
Loading...
Loading...