Amendment AA8-ASA2-AB50

AB50-ASA2-AA8,167,11 (a) “Covered entity” means an entity described in 42 USC 256b (a) (4) (A), (D), (E), (J), or (N) that participates in the federal drug pricing program under 42 USC 256b, a pharmacy of the entity, or a pharmacy contracted with the entity to dispense drugs purchased through the federal drug pricing program under 42 USC 256b.

AB50-ASA2-AA8,167,12 (b) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

AB50-ASA2-AA8,167,14 (2) No person, including a pharmacy benefit manager or 3rd-party payer, may do any of the following:

AB50-ASA2-AA8,167,18 (a) Reimburse a covered entity for a drug that is subject to an agreement under 42 USC 256b at a rate lower than that paid for the same drug to pharmacies that are not covered entities and have a similar prescription volume to that of the covered entity.

AB50-ASA2-AA8,167,21 (b) Assess a covered entity any fee, charge back, or other adjustment on the basis of the covered entity’s participation in the federal drug pricing program under 42 USC 256b.

AB50-ASA2-AA8,168,2 (3) The commissioner may promulgate rules to implement this section and to establish minimum reimbursement rates for covered entities and any other entity described under 42 USC 256b (a) (4).”.

AB50-ASA2-AA8,168,3 60. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,168,4 “Section 307. 601.31 (1) (nw) of the statutes is created to read:

AB50-ASA2-AA8,168,7 601.31 (1) (nw) For issuing or renewing a license as a pharmacy services administrative organization under s. 632.864, an amount to be set by the commissioner by rule.

AB50-ASA2-AA8,308 Section 308. 632.864 of the statutes is created to read:

AB50-ASA2-AA8,168,10 632.864 Pharmacy services administrative organizations. (1) Definitions. In this section:

AB50-ASA2-AA8,168,11 (a) “Administrative service” means any of the following:

AB50-ASA2-AA8,168,12 1. Assisting with claims.

AB50-ASA2-AA8,168,13 2. Assisting with audits.

AB50-ASA2-AA8,168,14 3. Providing centralized payment.

AB50-ASA2-AA8,168,15 4. Performing certification in a specialized care program.

AB50-ASA2-AA8,168,16 5. Providing compliance support.

AB50-ASA2-AA8,168,17 6. Setting flat fees for generic drugs.

AB50-ASA2-AA8,168,18 7. Assisting with store layout.

AB50-ASA2-AA8,168,19 8. Managing inventory.

AB50-ASA2-AA8,168,20 9. Providing marketing support.

AB50-ASA2-AA8,168,22 10. Providing management and analysis of payment and drug dispensing data.

AB50-ASA2-AA8,168,23 11. Providing resources for retail cash cards.

AB50-ASA2-AA8,169,3 (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.

AB50-ASA2-AA8,169,4 (c) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

AB50-ASA2-AA8,169,6 (d) “Pharmacy services administrative organization” means an entity operating in this state that does all of the following:

AB50-ASA2-AA8,169,8 1. Contracts with an independent pharmacy to conduct business with a 3rd- party payer on the independent pharmacy’s behalf.

AB50-ASA2-AA8,169,11 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 independent pharmacy.

AB50-ASA2-AA8,169,14 (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.

AB50-ASA2-AA8,169,21 (2) Licensure. (a) Beginning on the first day of the 12th month beginning after the effective date of this paragraph .... [LRB inserts date], no person may operate as a pharmacy services administrative organization without being licensed by the commissioner as a pharmacy services administrative organization under this subsection. In order to obtain a license under this paragraph, the person shall apply to the commissioner in the form and manner prescribed by the commissioner. The application for licensure under this paragraph shall include all of the following:

AB50-ASA2-AA8,169,23 1. The name, address, telephone number, and federal employer identification number of the applicant.

AB50-ASA2-AA8,170,2 2. The name, business address, and telephone number of a contact person for the applicant.

AB50-ASA2-AA8,170,3 3. The fee under s. 601.31 (1) (nw).

AB50-ASA2-AA8,170,4 4. Evidence of financial responsibility of at least $1,000,000.

AB50-ASA2-AA8,170,5 5. Any other information required by the commissioner.

AB50-ASA2-AA8,170,7 (b) The term of a license issued under par. (a) shall be 2 years from the date of issuance.

AB50-ASA2-AA8,170,12 (c) A license issued under par. (a) may be renewed. Renewal applications shall be submitted to the commissioner on a form provided by the commissioner and shall include all the items described in par. (a) 1. to 5. A renewal application under this paragraph may not be submitted more than 90 days prior to the end of the term of the license being renewed.

AB50-ASA2-AA8,170,16 (3) Disclosure to the commissioner. (a) A pharmacy services administrative organization licensed under sub. (2) 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:

AB50-ASA2-AA8,170,17 1. Provides pharmacy services.

AB50-ASA2-AA8,170,18 2. Provides prescription drug or device services.

AB50-ASA2-AA8,170,20 3. Manufactures, sells, or distributes prescription drugs, biologicals, or medical devices.

AB50-ASA2-AA8,170,23 (b) A pharmacy services administrative organization licensed under sub. (2) 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).

AB50-ASA2-AA8,171,2 (4) Rules. The commissioner may promulgate rules to implement this section.”.

AB50-ASA2-AA8,171,3 61. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,171,4 “Section 309. 46.48 (33) of the statutes is created to read:

AB50-ASA2-AA8,171,7 46.48 (33) Diaper bank grants. The department may distribute not more than $500,000 in each fiscal year as grants to diaper banks to provide diapers to families in need.

AB50-ASA2-AA8,9219 Section 9219. Fiscal changes; Health Services.

AB50-ASA2-AA8,171,13 (1) Diaper bank grants. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (1) (b), the dollar amount for fiscal year 2025-26 is increased by $500,000 and the dollar amount for fiscal year 2026-27 is increased by $500,000 to provide grants to diaper banks under s. 46.48 (33).”.

AB50-ASA2-AA8,171,14 62. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,171,15 “Section 310. 601.31 (1) (nv) of the statutes is created to read:

AB50-ASA2-AA8,171,17 601.31 (1) (nv) For issuing or renewing a license as a pharmaceutical representative under s. 632.863, an amount to be set by the commissioner by rule.

AB50-ASA2-AA8,311 Section 311. 632.863 of the statutes is created to read:

AB50-ASA2-AA8,171,20 632.863 Pharmaceutical representatives. (1) Definitions. In this section:

AB50-ASA2-AA8,171,23 (a) “Health care professional” means a physician or other health care practitioner who is licensed to provide health care services or to prescribe pharmaceutical or biologic products.

AB50-ASA2-AA8,172,2 (b) “Pharmaceutical” means a medication that may legally be dispensed only with a valid prescription from a health care professional.

AB50-ASA2-AA8,172,5 (c) “Pharmaceutical representative” means an individual who markets or promotes pharmaceuticals to health care professionals on behalf of a pharmaceutical manufacturer for compensation.

AB50-ASA2-AA8,172,13 (2) Licensure. Beginning on the first day of the 12th month beginning after the effective date of this subsection .... [LRB inserts date], no individual may act as a pharmaceutical representative in this state without being licensed by the commissioner as a pharmaceutical representative under this subsection. In order to obtain a license under this subsection, the individual shall apply to the commissioner in the form and manner prescribed by the commissioner and shall pay the fee under s. 601.31 (1) (nv). The term of a license issued under this subsection is one year, and the license is renewable.

AB50-ASA2-AA8,172,16 (3) Display of license. A pharmaceutical representative licensed under sub. (2) shall display the pharmaceutical representative’s license during each visit with a health care professional.

AB50-ASA2-AA8,172,20 (4) Enforcement. (a) Any individual who violates this section or any rules promulgated under this section shall be fined not less than $1,000 nor more than $3,000 for each offense. Each day of continued violation constitutes a separate offense.

AB50-ASA2-AA8,173,2 (b) The commissioner may suspend or revoke the license of a pharmaceutical representative who violates this section or any rules promulgated under this section. A suspended or revoked license under this paragraph may not be reinstated until the pharmaceutical representative remedies all violations related to the suspension or revocation and pays all assessed penalties and fees.

AB50-ASA2-AA8,173,5 (5) Rules. The commissioner shall promulgate rules to implement this section, including rules that require pharmaceutical representatives to complete continuing educational coursework as a condition of licensure.”.

AB50-ASA2-AA8,173,6 63. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,173,7 “Section 312. 601.31 (1) (mv) of the statutes is created to read:

AB50-ASA2-AA8,173,10 601.31 (1) (mv) For initial issuance or renewal of a license as a pharmacy benefit management broker or consultant under s. 628.495, amounts set by the commissioner by rule.

AB50-ASA2-AA8,313 Section 313. 628.495 of the statutes is created to read:

AB50-ASA2-AA8,173,14 628.495 Pharmacy benefit management broker and consultant licenses. (1) Definition. In this section, “pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

AB50-ASA2-AA8,173,19 (2) License required. Beginning on the first day of the 12th month beginning after the effective date of this subsection .... [LRB inserts date], no individual may act as a pharmacy benefit management broker or consultant and no individual may act to procure the services of a pharmacy benefit manager on behalf of a client without being licensed by the commissioner under this section.

AB50-ASA2-AA8,173,22 (3) Rules. The commissioner may promulgate rules to establish criteria and procedures for initial licensure and renewal of licensure and to implement licensure under this section.”.

AB50-ASA2-AA8,173,23 64. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,174,1 “Section 314. 632.865 (2m) of the statutes is created to read:

AB50-ASA2-AA8,174,5 632.865 (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.

AB50-ASA2-AA8,174,9 (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:

AB50-ASA2-AA8,174,11 1. The indirect profit received by the pharmacy benefit manager from owning any interest in a pharmacy or service provider.

AB50-ASA2-AA8,174,13 2. Any payment made by the pharmacy benefit manager to a consultant or broker who works on behalf of the health benefit plan sponsor.

AB50-ASA2-AA8,174,17 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.

AB50-ASA2-AA8,174,22 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.”.

AB50-ASA2-AA8,174,23 65. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,175,1 “Section 315. 609.74 of the statutes is created to read:

AB50-ASA2-AA8,175,3 609.74 Coverage of infertility services. Defined network plans and preferred provider plans are subject to s. 632.895 (15m).

AB50-ASA2-AA8,316 Section 316. 632.895 (15m) of the statutes is created to read:

AB50-ASA2-AA8,175,5 632.895 (15m) Coverage of infertility services. (a) In this subsection:

AB50-ASA2-AA8,175,11 1. “Diagnosis of and treatment for infertility” means any recommended procedure or medication to treat infertility at the direction of a physician that is consistent with established, published, or approved medical practices or professional guidelines from the American College of Obstetricians and Gynecologists, or its successor organization, or the American Society for Reproductive Medicine, or its successor organization.

AB50-ASA2-AA8,175,13 2. “Infertility” means a disease, condition, or status characterized by any of the following:

AB50-ASA2-AA8,175,18 a. The failure to establish a pregnancy or carry a pregnancy to a live birth after regular, unprotected sexual intercourse for, if the woman is under the age of 35, no longer than 12 months or, if the woman is 35 years of age or older, no longer than 6 months, including any time during those 12 months or 6 months that the woman has a pregnancy that results in a miscarriage.

AB50-ASA2-AA8,175,20 b. An individual’s inability to reproduce either as a single individual or with a partner without medical intervention.

AB50-ASA2-AA8,175,22 c. A physician’s findings based on a patient’s medical, sexual, and reproductive history, age, physical findings, or diagnostic testing.

AB50-ASA2-AA8,176,2 3. “Self-insured health plan” means a self-insured health plan of the state or a county, city, village, town, or school district.

AB50-ASA2-AA8,176,9 4. “Standard fertility preservation service” means a procedure that is consistent with established medical practices or professional guidelines published by the American Society for Reproductive Medicine, or its successor organization, or the American Society of Clinical Oncology, or its successor organization, for a person who has a medical condition or is expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impairment to fertility.

AB50-ASA2-AA8,176,17 (b) Subject to pars. (c) to (e), every disability insurance policy and self-insured health plan that provides coverage for medical or hospital expenses shall cover diagnosis of and treatment for infertility and standard fertility preservation services. Coverage required under this paragraph includes at least 4 completed oocyte retrievals with unlimited embryo transfers, in accordance with the guidelines of the American Society for Reproductive Medicine, or its successor organization, and single embryo transfer when recommended and medically appropriate.