Wisconsin Assembly Bill AB173

Wisconsin 2025-2026 Regular Session

• Introduced: 4/9/25
• Refer: 4/9/25

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

Should AB173 pass, it would have significant implications for pharmacy operations and patient access to medications. The bill prohibits PBMs from engaging in practices that might discriminate against pharmacies, especially those participating in the federal 340B drug pricing program, which aids entities that serve low-income patients. This could benefit both independent pharmacies and patients who depend on these resources for affordable medications. Additionally, it mandates the timely payment of claims to pharmacies, improving cash flow for these businesses and reducing barriers to accessing medications for patients.

Summary

Assembly Bill 173 seeks to enhance the regulation of pharmacy benefit managers (PBMs) and their interactions with pharmacies and pharmacists in Wisconsin. The legislation aims to ensure that pharmacies are reimbursed fairly and transparently, establishing clear guidelines for PBMs regarding cost structures, reimbursement rates, and maximum allowable costs for pharmaceutical products. One of the core provisions includes mandating that PBMs provide enrollees and sponsors with full access to drug formularies, allowing consumers to make informed choices regarding their prescription drug benefits.

Contention

Despite its intended benefits, AB173 has generated some discussion among stakeholders. Proponents argue that the bill will level the playing field for pharmacies and improve patient access to medications, while opponents caution that increased regulations could lead to unintended consequences such as reduced competition among pharmacies or higher overall costs for consumers. Some legislators suggest that the regulations could limit the flexibility of PBMs to negotiate discounts, which could adversely affect pricing and availability of certain drugs. As discussions continue, the focus remains on finding a balance that best serves both healthcare providers and patients.