AB68,1540,25 3. Manufactures, sells, or distributes prescription drugs, biologicals, or medical devices.

AB68,1541,3 (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).

AB68,1541,4 (4) Rules. The commissioner may promulgate rules to implement this section.

AB68,2959 Section 2959 . 632.865 (1) (a) of the statutes is renumbered 632.865 (1) (aw).

AB68,2960 Section 2960 . 632.865 (1) (ae) and (ak) of the statutes are created to read:

AB68,1541,7 632.865 (1) (ae) “Health benefit plan” has the meaning given in s. 632.745 (11).

AB68,1541,8 (ak) “Health care provider” has the meaning given in s. 146.81 (1).

AB68,2961 Section 2961 . 632.865 (1) (c) of the statutes is renumbered 632.865 (1) (c) (intro.) and amended to read:

AB68,1541,13 632.865 (1) (c) (intro.) “Pharmacy benefit manager" means an entity doing business in this state that contracts to administer or manage prescription drug benefits on behalf of any of the following:

AB68,1541,14 1. An insurer or other.

AB68,1541,16 3. Another entity that provides prescription drug benefits to residents of this state.

AB68,2962 Section 2962 . 632.865 (1) (c) 2. of the statutes is created to read:

AB68,1541,18 632.865 (1) (c) 2. A cooperative, as defined in s. 185.01 (2).

AB68,2963 Section 2963 . 632.865 (1) (dm) of the statutes is created to read:

AB68,1541,20 632.865 (1) (dm) “Prescription drug" has the meaning given in s. 450.01 (20).

AB68,2964 Section 2964. 632.865 (2m) of the statutes is created to read:

AB68,1541,25 632.865 (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.

AB68,1542,3 (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:

AB68,1542,5 1. The indirect profit received by the pharmacy benefit manager from owning any interest in a pharmacy or service provider.

AB68,1542,7 2. Any payment made by the pharmacy benefit manager to a consultant or broker who works on behalf of the health benefit plan sponsor.

AB68,1542,11 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.

AB68,1542,16 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.

AB68,2965 Section 2965 . 632.865 (3) to (7) of the statutes are created to read:

AB68,1542,20 632.865 (3) License required. No person may perform any activities of a pharmacy benefit manager without being licensed by the commissioner as an administrator or pharmacy benefit manager under s. 633.14.

AB68,1543,2 (4) Accreditation for network participation. A pharmacy benefit manager or a representative of a pharmacy benefit manager shall provide to a pharmacy, within 30 days of receipt of a written request from the pharmacy, a written notice of any certification or accreditation requirements used by the pharmacy benefit manager or its representative as a determinant of network participation. A pharmacy benefit manager or a representative of a pharmacy benefit manager may change its accreditation requirements no more frequently than once every 12 months.

AB68,1543,5 (5) Retroactive claim reduction. Unless required otherwise by federal law, a pharmacy benefit manager may not retroactively deny or reduce a pharmacist's or pharmacy's claim after adjudication of the claim unless any of the following is true:

AB68,1543,6 (a) The original claim was submitted fraudulently.

AB68,1543,9 (b) The payment for the original claim was incorrect. Recovery for an incorrect payment under this paragraph is limited to the amount that exceeds the allowable claim.

AB68,1543,10 (c) The pharmacy services were not rendered by the pharmacist or pharmacy.