AB773,,4040(f) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c). AB773,,4141(g) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c). AB773,,4242(2) Application of payments. Except as provided in sub. (4), a disability insurance policy that offers a prescription drug benefit, a self-insured health plan, or a pharmacy benefit manager acting on behalf of a disability insurance policy or self-insured health plan shall apply to any cost-sharing requirement or to any calculation of an out-of-pocket maximum amount of the disability insurance policy or self-insured health plan, including the annual limitations on cost sharing established under 42 USC 18022 (c) and 42 USC 300gg-6 (b), any amounts paid by an enrollee or other individual covered under the disability insurance policy or self-insured health plan, or by any person on behalf of the enrollee or individual, for brand name drugs that are covered under the disability insurance policy or self-insured health plan. AB773,,4343(3) Calculation of cost-sharing annual limitations. For purposes of calculating an enrollee’s contribution to the annual limitation on cost sharing under 42 USC 18022 (c) and 42 USC 300gg-6 (b), a disability insurance policy that offers a prescription drug benefit, a self-insured health plan, or a pharmacy benefit manager acting on behalf of a disability insurance policy or self-insured health plan shall include expenditures for any item or service covered under the disability insurance policy or self-insured health plan if the item or service is included within a category of essential health benefits, as described in 42 USC 18022 (b) (1), and regardless of whether the disability insurance policy, self-insured health plan, or pharmacy benefit manager classifies the item or service as an essential health benefit. AB773,,4444(4) Exception; high deductible health plans. If applying the requirement under sub. (2) to payments made by or on behalf of an enrollee or other individual covered under a high deductible health plan, as defined under 26 USC 223 (c) (2), would result in the enrollee failing to meet the definition of an eligible individual under 26 USC 223 (c) (1), the disability insurance policy, self-insured health plan, or pharmacy benefit manager shall begin applying the requirement under sub. (2) to the disability insurance policy or self-insured health plan’s deductible after the enrollee has satisfied the minimum deductible requirement under 26 USC 223 (c) (2) (A) (i). This subsection does not apply to any amounts paid for items or services that are preventive care, as described in 26 USC 223 (c) (2) (C). AB773,1345Section 13. 632.865 (1) (ab) and (ac) of the statutes are created to read: AB773,,4646632.865 (1) (ab) “340B covered entity” has the meaning given for “covered entity” under 42 USC 256b (a) (4). AB773,,4747(ac) “340B drug” has the meaning given for “covered drug” under 42 USC 256b (b) (2). AB773,1448Section 14. 632.865 (1) (ae) of the statutes is amended to read: AB773,,4949632.865 (1) (ae) “Health benefit plan” has the meaning given means a health benefit plan, as defined in s. 632.745 (11), that is not prescription drug coverage provided under part D of medicare under Title XVIII of the federal Social Security Act, 42 USC 1395 to 1395lll. AB773,1550Section 15. 632.865 (1) (an), (aq), and (at) of the statutes are created to read: AB773,,5151632.865 (1) (an) “Maximum allowable cost list” means a list of pharmaceutical products that sets forth the maximum amount a pharmacy benefit manager will pay to a pharmacy or pharmacist for dispensing a pharmaceutical product. The list may directly establish the maximum amounts or set forth a method for how the maximum amounts are calculated. AB773,,5252(aq) “Pharmaceutical product” means a prescription generic drug, prescription brand-name drug, prescription biologic, or other prescription drug, vaccine, or device. AB773,,5353(at) “Pharmaceutical wholesaler” means a person that sells and distributes, directly or indirectly, a pharmaceutical product and that offers to deliver the pharmaceutical product to a pharmacy or pharmacist. AB773,1654Section 16. 632.865 (1) (bm) of the statutes is created to read: AB773,,5555632.865 (1) (bm) “Pharmacy acquisition cost” means the amount that a pharmaceutical wholesaler charges a pharmacy or pharmacist for a pharmaceutical product as listed on the pharmacy’s or pharmacist’s billing invoice. AB773,1756Section 17. 632.865 (1) (cg) and (cr) of the statutes are created to read: AB773,,5757632.865 (1) (cg) “Pharmacy benefit manager affiliate” means a pharmacy or pharmacist that is an affiliate of a pharmacy benefit manager. AB773,,5858(cr) “Pharmacy services administrative organization” means an entity that provides contracting and other administrative services to pharmacies or pharmacists to assist them in their interactions with 3rd-party payers, pharmacy benefit managers, pharmaceutical wholesalers, and other entities. AB773,1859Section 18. 632.865 (2) of the statutes is repealed. AB773,1960Section 19. 632.865 (2d) of the statutes is created to read: AB773,,6161632.865 (2d) Pharmaceutical product reimbursements. (ag) Contents of maximum allowable cost lists. A pharmacy benefit manager that uses a maximum allowable cost list shall include all of the following information on the maximum allowable cost list: AB773,,62621. The average acquisition cost of each pharmaceutical product and the cost of the pharmaceutical product set forth in the national average drug acquisition cost data published by the federal centers for medicare and medicaid services. AB773,,63632. The average manufacturer price of each pharmaceutical product. AB773,,64643. The average wholesale price of each pharmaceutical product. AB773,,65654. The brand effective rate or generic effective rate for each pharmaceutical product. AB773,,66665. Any applicable discount indexing. AB773,,67676. The federal upper limit for each pharmaceutical product published by the federal centers for medicare and medicaid services. AB773,,68687. The wholesale acquisition cost of each pharmaceutical product.