AB7,10 13Section 10 . 601.31 (1) (w) of the statutes is amended to read:
AB7,7,1514 601.31 (1) (w) For initial issuance and for each annual renewal of a license as
15an administrator or pharmacy benefit manager under ch. 633, $100.
AB7,11 16Section 11 . 601.46 (3) (b) of the statutes is amended to read:
AB7,7,1917 601.46 (3) (b) A general review of the insurance business in this state, including
18a report on emerging regulatory problems, developments and trends , including
19trends related to prescription drugs
;
AB7,12 20Section 12 . 609.83 of the statutes is amended to read:
AB7,7,23 21609.83 Coverage of drugs and devices. Limited service health
22organizations, preferred provider plans, and defined network plans are subject to ss.
23632.853, 632.861, and 632.895 (16t) and (16v).
AB7,13 24Section 13 . 616.09 (1) (a) 2. of the statutes is amended to read:
AB7,8,4
1616.09 (1) (a) 2. Plans authorized under s. 616.06 are subject to s. 610.21, 1977
2stats., s. 610.55, 1977 stats., s. 610.57, 1977 stats., and ss. 628.34 to 628.39, 1977
3stats., to chs. 600, 601, 620, 625, 627 and 645, to ss. 632.72, 632.755, 632.86 632.861
4and 632.87 and to this subchapter except s. 616.08.
AB7,14 5Section 14 . 632.86 of the statutes is repealed.
AB7,15 6Section 15 . 632.861 of the statutes is created to read:
AB7,8,7 7632.861 Prescription drug charges. (1) Definitions. In this section:
AB7,8,88 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB7,8,109 (b) “Enrollee” means an individual who is covered under a disability insurance
10policy or a self-insured health plan.
AB7,8,1111 (c) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
AB7,8,1212 (d) “Prescription drug” has the meaning given in s. 450.01 (20).
AB7,8,1313 (e) “Prescription drug benefit” has the meaning given in s. 632.865 (1) (e).
AB7,8,1414 (f) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB7,8,22 15(2) Allowing disclosures. (a) A disability insurance policy or self-insured
16health plan that provides a prescription drug benefit may not restrict, directly or
17indirectly, any pharmacy that dispenses a prescription drug to an enrollee in the
18policy or plan from informing, or penalize such pharmacy for informing, an enrollee
19of any differential between the out-of-pocket cost to the enrollee under the policy or
20plan with respect to acquisition of the drug and the amount an individual would pay
21for acquisition of the drug without using any health plan or health insurance
22coverage.
AB7,9,623 (b) A disability insurance policy or self-insured health plan that provides a
24prescription drug benefit shall ensure that any pharmacy benefit manager that
25provides services under a contract with the policy or plan does not, with respect to

1such policy or plan, restrict, directly or indirectly, any pharmacy that dispenses a
2prescription drug to an enrollee in the policy or plan from informing, or penalize such
3pharmacy for informing, an enrollee of any differential between the out-of-pocket
4cost to the enrollee under the policy or plan with respect to acquisition of the drug
5and the amount an individual would pay for acquisition of the drug without using
6any health plan or health insurance coverage.
AB7,9,11 7(3) Cost-sharing limitation. (a) A disability insurance policy or self-insured
8health plan that provides a prescription drug benefit or a pharmacy benefit manager
9that provides services under a contract with a policy or plan may not require an
10enrollee to pay at the point of sale for a covered prescription drug an amount that is
11greater than the lowest of all of the following amounts:
AB7,9,1312 1. The cost-sharing amount for the prescription drug for the enrollee under the
13policy or plan.
AB7,9,1614 2. The amount a person would pay for the prescription drug if the enrollee
15purchased the prescription drug at the dispensing pharmacy without using any
16health plan or health insurance coverage.
AB7,9,25 17(4) Drug substitution. (a) Except as provided in par. (b), a disability insurance
18policy that offers a prescription drug benefit, a self-insured health plan that offers
19a prescription drug benefit, or a pharmacy benefit manager acting on behalf of a
20disability insurance policy or self-insured health plan shall provide to an enrollee
21advanced written notice of a formulary change that removes a prescription drug from
22the formulary of the policy or plan or that reassigns a prescription drug to a benefit
23tier for the policy or plan that has a higher deductible, copayment, or coinsurance.
24The advanced written notice of a formulary change under this paragraph shall be
25provided no fewer than 30 days before the expected date of the removal or

1reassignment and shall include information on the procedure for the enrollee to
2request an exception to the formulary change. The policy, plan, or pharmacy benefit
3manager is required to provide the advanced written notice under this paragraph
4only to those enrollees in the policy or plan who are using the drug at the time the
5notification must be sent according to available claims history.
AB7,10,86 (b) 1. A disability insurance policy, self-insured health plan, or pharmacy
7benefit manager is not required to provide advanced written notice under par. (a) if
8the prescription drug that is to be removed or reassigned is any of the following:
AB7,10,99 a. No longer approved by the federal food and drug administration.
AB7,10,1210 b. The subject of a notice, guidance, warning, announcement, or other
11statement from the federal food and drug administration relating to concerns about
12the safety of the prescription drug.
AB7,10,1413 c. Approved by the federal food and drug administration for use without a
14prescription.
AB7,10,2215 2. A disability insurance policy, self-insured health plan, or pharmacy benefit
16manager is not required to provide advanced written notice under par. (a) if, for the
17prescription drug that is being removed from the formulary or reassigned to a benefit
18tier that has a higher deductible, copayment, or coinsurance, the policy, plan, or
19pharmacy benefit manager adds to the formulary a generic prescription drug that
20is approved by the federal food and drug administration for use as an alternative to
21the prescription drug or a prescription drug in the same pharmacologic class or with
22the same mechanism of action at any of the following benefit tiers:
AB7,10,2423 a. The same benefit tier from which the prescription drug is being removed or
24reassigned.