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 entity’s 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-AA8,168,75601.31 (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-AA8,168,109632.864 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 pharmacy’s 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-AA8,171,7546.48 (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-AA8,171,139(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-AA8,171,1716601.31 (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-AA8,171,2019632.863 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 representative’s 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-AA8,173,108601.31 (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-AA8,173,1412628.495 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-AA8,174,52632.865 (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 sponsor’s 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 sponsor’s 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 manager’s 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-AA8,175,32609.74 Coverage of infertility services. Defined network plans and 3preferred provider plans are subject to s. 632.895 (15m). 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 individual’s inability to reproduce either as a single individual or with a 20partner without medical intervention. AB50-ASA2-AA8,175,2221c. A physician’s findings based on a patient’s 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. AB50-ASA2-AA8,176,1918(c) 1. A disability insurance policy or self-insured health plan may not do any 19of the following:
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