Wisconsin Senate Bill SB737

Wisconsin 2023-2024 Regular Session

• Introduced: 12/1/23
• Refer: 12/1/23
• Failed: 4/15/24

Caption

Regulation of pharmacy benefit managers, fiduciary and disclosure requirements on pharmacy benefit managers, and application of prescription drug payments to health insurance cost-sharing requirements. (FE)

Impact

The implications of this bill extend to various statutes governing health care coverage and pharmacy practice. By enforcing stricter fiduciary and disclosure requirements on PBMs, the bill seeks to protect health benefit plan sponsors and ensure ethical practices within the pharmaceutical supply chain. Moreover, the requirement for equal reimbursement rates among pharmacies within the same network intends to promote a level playing field and avert potential discrimination against independent or smaller pharmacy operators. This could enhance the operational viability of such pharmacies and improve patient access to medications.

Summary

Senate Bill 737 introduces significant changes to the regulation of pharmacy benefit managers (PBMs) and their relationships with pharmacies and pharmacists in the state of Wisconsin. The bill mandates that PBMs pay pharmacies a professional dispensing fee and prohibits them from charging fees that could financially burden the pharmacies. This legislation aims to enhance transparency and fairness in the reimbursement process for pharmacies, especially concerning the costs of pharmaceuticals dispensed to patients. Additionally, the bill ensures that reimbursements are not discriminatory towards pharmacies associated with the federal 340B drug pricing program, which is vital for serving low-income patients.

Contention

Despite its potential benefits, Senate Bill 737 faces opposition, particularly concerning the increased regulatory burden it may impose on PBMs. Some stakeholders argue that the enhanced regulations could result in higher costs for health plans, which might ultimately be passed down to consumers in the form of increased premiums or reduced coverage options. Furthermore, critics point out that while the bill aims to prevent discrimination against pharmacies within the 340B program, it may inadvertently complicate the operational frameworks of PBMs, leading to inefficiencies in the pharmaceuticals distribution system. This tension between regulation and operational efficiency remains a key point of contention in discussions surrounding the bill.