AB114,13,16 (c) Misappropriates or converts for the registrant's own use or improperly withholds insurance premiums or contributions held in a fiduciary capacity, except for any interest earnings received by the pharmacy benefit manager and disclosed to the pharmacist, pharmacy, or health benefit plan sponsor with which the pharmacy benefit manager has a contract to provide services.

AB114,13,18 (d) Commits fraudulent, coercive, or dishonest practices in the transaction of business as a pharmacy benefit manager.

AB114,13,21 (e) Uses, or knowingly permits the use of, any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading.

AB114,13,24 (f) Has a license or registration suspended, revoked, or not renewed in any other state, district, territory, or province that impacts business conducted in this state.

AB114,14,2 (g) Knowingly violates a requirement of this chapter or ch. 632 or a rule promulgated under this chapter or ch. 632.

AB114,14,5 (2) Any person who performs the activities of a pharmacy benefit manager in this state without a valid registration under s. 649.05 is subject to a forfeiture of $500 for each day of violation.

AB114,14,6 649.30 Pricing transparency; prohibitions; contracts.

AB114,14,8 (2) Prohibitions. A pharmacy benefit manager or a representative of a pharmacy benefit manager may not do any of the following:

AB114,14,12 (a) Unless approved by the commissioner, charge a pharmacist or pharmacy a fee related to the adjudication of a claim, including a fee for receiving and processing a pharmacy claim, developing or managing claims processing services in a pharmacy benefit manager network, or participating in a pharmacy benefit manager network.

AB114,14,16 (b) Unless approved by the commissioner after consulting with the pharmacy examining board, require pharmacist or pharmacy accreditation standards or certification requirements in addition to, more stringent than, or inconsistent with any requirements of the pharmacy examining board.

AB114,14,21 (c) Reimburse a pharmacy or pharmacist in this state an amount less than the amount that the pharmacy benefit manager reimburses an affiliate of the pharmacy benefit manager for providing the same services. To comply with this paragraph, the pharmacy benefit manager shall compare the amounts calculated on a per-unit basis using the same generic product identifier or generic code number.

AB114,14,24 (d) After termination of a pharmacy or pharmacist from a pharmacy benefit network, fail to make payments to a pharmacist or pharmacy for services that were properly rendered and provided before termination.

AB114,15,5 (e) Prohibit, restrict, or limit a pharmacy or pharmacist from disclosing information to the commissioner, law enforcement, or a state or federal governmental official that is investigating or examining a complaint or conducting a review of a pharmacy benefit manager's compliance with the requirements under this section.

AB114,15,10 (3) Conflict of interest; business practices. (a) If a pharmacy benefit manager makes a formulary substitution in which the substitute drug costs more than the originally prescribed drug, the pharmacy benefit manager shall disclose to the health benefit plan sponsor the cost of the drugs and any benefit that accrues, directly or indirectly, to the pharmacy benefit manager related to the substitution.

AB114,15,12 (b) A pharmacy benefit manager may not require that a pharmacy or pharmacist enter into one contract in order to enter into another contract.

AB114,15,16 (c) A pharmacy benefit manager shall notify a health benefit plan sponsor in writing of any activity, policy, or practice of the pharmacy benefit manager that presents a conflict of interest, directly or indirectly, with any requirement of this section.

AB114,15,19 (4) Retroactive claim reduction. 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:

AB114,15,20 (a) The original claim was submitted fraudulently.

AB114,15,22 (b) The payment for the original claim was incorrect because the pharmacy or pharmacist had already been paid for the pharmacy services.

AB114,15,23 (c) The pharmacy services were not rendered by the pharmacist or pharmacy.

AB114,16,2 649.35 Audits of pharmacies or pharmacists. (1) Definition. In this section, “entity” means a defined network plan, as defined in s. 609.01 (1b), insurer, 3rd-party payer, or pharmacy benefit manager or a person acting on behalf of a defined network plan, insurer, 3rd-party payer, or pharmacy benefit manager.

AB114,16,4 (2) Audit procedure requirements. An entity conducting an audit of pharmacist or pharmacy records shall do all of the following:

AB114,16,7 (a) If the audit is an audit on the premises of the pharmacist or pharmacy, notify the pharmacist or pharmacy in writing of the audit at least 2 weeks before conducting the audit.

AB114,16,9 (b) Refrain from auditing a pharmacist or pharmacy within the first 7 days of a month unless the pharmacist or pharmacy consents to an audit during that time.

AB114,16,12 (c) If the audit involves clinical or professional judgement, conduct the audit by or in consultation with a pharmacist licensed in this state or the pharmacy examining board.

AB114,16,14 (d) Limit the audit review to claims submitted no more than 2 years before the date of the audit.

AB114,16,16 (e) Audit each pharmacist or pharmacy under the same standards and parameters as other similarly situated pharmacists or pharmacies.

AB114,16,18 (f) Establish a written appeals process that allows appeals of preliminary and final reports and allows for mediation if either party is dissatisfied with the appeal.

AB114,16,23 (g) Allow the pharmacist or pharmacy to use records of a hospital, physician, or other health care provider to validate the pharmacist's or pharmacy's records and use any prescription that complies with requirements of the pharmacy examining board to validate claims in connection with a prescription, refill of a prescription, or change in prescription.