Earlier today, the Wisconsin State Legislature announced a second comprehensive PBM reform bill to address practices harmful to patients and pharmacies, the Pharmacy Benefit Manager Accountability Act. These proposed reforms build upon 2021 Act 9, which has been implemented. PSW has spent significant time advocating for the proposed reforms and sharing our expertise throughout the drafting process.

What's In the Bill?

• Requirement that dispensing fees from PBMs are equal to or greater than those provided by the Medicaid program
• Prohibition on adjudication, performance-based, network participation, or accreditation fees by pharmacies
• Prohibition of accreditation requirements 
• Any willing pharmacy provisions, including allowance to be in preferred or non-preferred networks
• Ban on differential copays; ban on incentives/penalties for the use of specific in-network pharmacy; prohibition of mandatory mail-order or use of specific pharmacy within the network (or patient penalties for not using a specific pharmacy)
• Reforms to the existing MAC transparency laws to enhance enforceability
• Prohibition on reimbursing affiliated pharmacies more than unaffiliated pharmacies
• Allowance for a pharmacy to refuse to fill prescriptions that would be reimbursed at a rate lower than the pharmacy's acquisition cost
• Fiduciary responsibility owed by PBM to health plan sponsor; related transparency reporting requirement
• 340b discrimination provisions, including differential requirements, restrictions, or reimbursements
• Application of copay assistance cards to patients' copay and out-of-pocket maximum amounts
• Prohibition of retaliation by PBMs against pharmacies/pharmacists for reporting violations of laws or exercising their rights 

What's Next?

The bill will be circulated for co-sponsorship; please encourage your legislators to co-sponsor the bill by clicking here. After the co-sponsorship period, the bill will be formally introduced; at this point, legislative hearings can be scheduled and the various procedural votes may commence. PSW will continue our significant lobbying and advocacy work throughout this process as we anticipate significant pushback from PBMs.

What Can I Do to Support This Legislation?

Right now, you can ask your legislators to sign on as a co-sponsor by clicking here.

As the legislative process progresses, stay tuned to FastFacts for more advocacy opportunities!

PBM reform will be a significant topic at PSW Legislative Day 2024 on Wednesday, February 21. Be sure to save the date and stay tuned to FastFacts for registration information.

What Laws Govern PBMs Now?

For more information on existing PBM laws in Wisconsin and how to file a complaint for violating an existing law, click here.