AB68: Bill Text

AB68,1536,5 (c) A pharmaceutical representative shall display his or her license during each visit with a health care professional.

AB68,1536,10 (3) Professional education requirements. (a) In order to become initially licensed under sub. (2) (a), a pharmaceutical representative shall complete a professional education course as determined by the commissioner. A pharmaceutical representative shall, upon request, provide the commissioner with proof of the coursework's completion.

AB68,1536,14 (b) In order to renew a license under sub. (2) (a), a pharmaceutical representative shall complete a minimum of 5 hours of continuing professional education courses. A pharmaceutical representative shall, upon request, provide the commissioner with proof of the coursework's completion.

AB68,1536,18 (c) The professional education coursework required under pars. (a) and (b) shall include training in ethical standards, whistleblower protections, laws and rules applicable to pharmaceutical marketing, and other areas that the commissioner may identify by rule.

AB68,1536,20 (d) The commissioner shall regularly designate courses that fulfill the requirements under this subsection and publish a list of the designated courses.

AB68,1536,25 (e) The professional education coursework required under this subsection may not be provided by the employer of a pharmaceutical representative or be funded, in any way, by the pharmaceutical industry or a 3rd party funded by the pharmaceutical industry. A provider of a course designated under par. (d) shall disclose any conflict of interest.

AB68,1537,4 (4) Disclosure to commissioner. (a) No later than June 1 of each year, a pharmaceutical representative shall provide to the commissioner, in the manner prescribed by the commissioner, all of the following information from the previous calendar year:

AB68,1537,7 1. The total number of times the pharmaceutical representative contacted health care professionals in this state and the specialties of the health care professionals contacted.

AB68,1537,11 2. For each contact with a health care professional in this state, the location and duration of the contact, the pharmaceuticals for which the pharmaceutical representative provides information, and the value of any item, including a product sample, compensation, material, or gift, provided to the health care professional.

AB68,1537,14 (b) The commissioner shall publish the information provided under par. (a) on the commissioner's Internet site in a manner in which individual health care professionals are not identifiable by name or other identifiers.

AB68,1537,20 (5) Disclosure to health care professionals. During each contact with a health care professional, a pharmaceutical representative shall disclose the wholesale acquisition cost of any pharmaceutical for which the pharmaceutical representative provides information and the names of at least 3 generic prescription drugs from the same therapeutic class, or if 3 are not available, as many as are available for prescriptive use.

AB68,1537,25 (6) Ethical standards. The commissioner shall promulgate a rule that contains ethical standards for pharmaceutical representatives and shall publish the ethical standards on the commissioner's Internet site. In addition to the ethical standards contained in the rule, a pharmaceutical representative may not do any of the following:

AB68,1538,3 (a) Engage in deceptive or misleading marketing of a pharmaceutical, including the knowing concealment, suppression, omission, misleading representation, or misstatement of a material fact.

AB68,1538,8 (b) Use a title or designation that could reasonably lead a licensed health care professional, or an employee or representative of a licensed health care professional, to believe that the pharmaceutical representative is licensed to practice medicine, nursing, dentistry, optometry, pharmacy, or other similar health occupation in this state unless the pharmaceutical representative holds a license to practice.

AB68,1538,9 (c) Attend a patient examination without the patient's consent.

AB68,1538,12 (7) Enforcement. (a) Any individual violating this section shall be fined not less than $1,000 nor more than $3,000 for each offense. Each day the violation continues shall constitute a separate offense.

AB68,1538,18 (b) The commissioner may suspend or revoke the license of a pharmaceutical representative who violates this section. A suspended or revoked license may not be reinstated until all violations related to the suspension or revocation have been remedied and all assessed penalties and fees have been paid. An individual whose pharmaceutical representative license is revoked for any cause may not be issued a license under sub. (2) (a) until at least 2 years after the date of revocation.

AB68,1538,22 (c) A health care professional who meets with a pharmaceutical representative who does not display his or her license or share the information required under sub. (5) may report the pharmaceutical representative to the commissioner for further action.

AB68,1538,23 (8) Rules. The commissioner may promulgate rules to implement this section.

AB68,2958 Section 2958. 632.864 of the statutes is created to read:

AB68,1539,2 632.864 Pharmacy services administrative organizations. (1) Definitions. In this section:

AB68,1539,3 (a) “Administrative service” means any of the following:

AB68,1539,4 1. Assisting with claims.

AB68,1539,5 2. Assisting with audits.

AB68,1539,6 3. Providing centralized payment.

AB68,1539,7 4. Performing certification in a specialized care program.

AB68,1539,8 5. Providing compliance support.

AB68,1539,9 6. Setting flat fees for generic drugs.

AB68,1539,10 7. Assisting with store layout.

AB68,1539,11 8. Managing inventory.

AB68,1539,12 9. Providing marketing support.

AB68,1539,13 10. Providing management and analysis of payment and drug dispensing data.

AB68,1539,14 11. Providing resources for retail cash cards.

AB68,1539,17 (b) “Independent pharmacy" means a pharmacy operating in this state that is licensed under s. 450.06 or 450.065 and is under common ownership with no more than 2 other pharmacies.

AB68,1539,18 (c) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

AB68,1539,20 (d) “Pharmacy services administrative organization” means an entity operating in this state that does all of the following:

AB68,1539,22 1. Contracts with an independent pharmacy to conduct business on the pharmacy's behalf with a 3rd-party payer.

AB68,1539,25 2. Provides at least one administrative service to an independent pharmacy and negotiates and enters into a contract with a 3rd-party payer or pharmacy benefit manager on behalf of the pharmacy.

AB68,1540,3 (e) “Third-party payer” means an entity, including a plan sponsor, health maintenance organization, or insurer, operating in this state that pays or insures health, medical, or prescription drug expenses on behalf of beneficiaries.

AB68,1540,8 (2) Licensure. (a) A person may not operate as a pharmacy services administrative organization in this state without a pharmacy services administrative organization license. In order to obtain a license, a person shall apply to the commissioner in the form and manner prescribed by the commissioner. The application shall include all of the following:

AB68,1540,10 1. The name, address, telephone number, and federal employer identification number of the applicant.

AB68,1540,12 2. The name, business address, and telephone number of a contact person for the applicant.

AB68,1540,13 3. The fee under s. 601.31 (1) (nw).

AB68,1540,14 4. Evidence of financial responsibility of at least $1,000,000.

AB68,1540,15 5. Any other information required by the commissioner.

AB68,1540,17 (b) The term of a license issued under par. (a) shall be 2 years from the date of issuance.

AB68,1540,21 (3) Disclosure to the commissioner. (a) A pharmacy services administrative organization shall disclose to the commissioner the extent of any ownership or control of the pharmacy services administrative organization by an entity that does any of the following:

AB68,1540,22 1. Provides pharmacy services.

AB68,1540,23 2. Provides prescription drug or device services.

AB68,1540,25 3. Manufactures, sells, or distributes prescription drugs, biologicals, or medical devices.

AB68,1541,3 (b) A pharmacy services administrative organization shall notify the commissioner in writing within 5 days of any material change in its ownership or control relating to an entity described in par. (a).

AB68,1541,4 (4) Rules. The commissioner may promulgate rules to implement this section.

AB68,2959 Section 2959 . 632.865 (1) (a) of the statutes is renumbered 632.865 (1) (aw).

AB68,2960 Section 2960 . 632.865 (1) (ae) and (ak) of the statutes are created to read:

AB68,1541,7 632.865 (1) (ae) “Health benefit plan” has the meaning given in s. 632.745 (11).

AB68,1541,8 (ak) “Health care provider” has the meaning given in s. 146.81 (1).

AB68,2961 Section 2961 . 632.865 (1) (c) of the statutes is renumbered 632.865 (1) (c) (intro.) and amended to read:

AB68,1541,13 632.865 (1) (c) (intro.) “Pharmacy benefit manager" means an entity doing business in this state that contracts to administer or manage prescription drug benefits on behalf of any of the following:

AB68,1541,14 1. An insurer or other.

AB68,1541,16 3. Another entity that provides prescription drug benefits to residents of this state.

AB68,2962 Section 2962 . 632.865 (1) (c) 2. of the statutes is created to read:

AB68,1541,18 632.865 (1) (c) 2. A cooperative, as defined in s. 185.01 (2).

AB68,2963 Section 2963 . 632.865 (1) (dm) of the statutes is created to read:

AB68,1541,20 632.865 (1) (dm) “Prescription drug" has the meaning given in s. 450.01 (20).

AB68,2964 Section 2964. 632.865 (2m) of the statutes is created to read:

AB68,1541,25 632.865 (2m) Fiduciary duty and disclosures to health benefit plan sponsors. (a) A pharmacy benefit manager owes a fiduciary duty to the health benefit plan sponsor to act according to the health benefit plan sponsor's instructions and in the best interests of the health benefit plan sponsor.

AB68,1542,3 (b) A pharmacy benefit manager shall annually provide, no later than the date and using the method prescribed by the commissioner by rule, the health benefit plan sponsor all of the following information from the previous calendar year:

AB68,1542,5 1. The indirect profit received by the pharmacy benefit manager from owning any interest in a pharmacy or service provider.

AB68,1542,7 2. Any payment made by the pharmacy benefit manager to a consultant or broker who works on behalf of the health benefit plan sponsor.

AB68,1542,11 3. From the amounts received from all drug manufacturers, the amounts retained by the pharmacy benefit manager, and not passed through to the health benefit plan sponsor, that are related to the health benefit plan sponsor's claims or bona fide service fees.

AB68,1542,16 4. The amounts, including pharmacy access and audit recovery fees, received from all pharmacies that are in the pharmacy benefit manager's network or have a contract to be in the network and, from these amounts, the amount retained by the pharmacy benefit manager and not passed through to the health benefit plan sponsor.

AB68,2965 Section 2965 . 632.865 (3) to (7) of the statutes are created to read:

AB68,1542,20 632.865 (3) License required. No person may perform any activities of a pharmacy benefit manager without being licensed by the commissioner as an administrator or pharmacy benefit manager under s. 633.14.

AB68,1543,2 (4) Accreditation for network participation. A pharmacy benefit manager or a representative of a pharmacy benefit manager shall provide to a pharmacy, within 30 days of receipt of a written request from the pharmacy, a written notice of any certification or accreditation requirements used by the pharmacy benefit manager or its representative as a determinant of network participation. A pharmacy benefit manager or a representative of a pharmacy benefit manager may change its accreditation requirements no more frequently than once every 12 months.

AB68,1543,5 (5) Retroactive claim reduction. Unless required otherwise by federal law, 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:

AB68,1543,6 (a) The original claim was submitted fraudulently.

AB68,1543,9 (b) The payment for the original claim was incorrect. Recovery for an incorrect payment under this paragraph is limited to the amount that exceeds the allowable claim.

AB68,1543,10 (c) The pharmacy services were not rendered by the pharmacist or pharmacy.

AB68,1543,12 (d) In making the claim or performing the service that is the basis for the claim, the pharmacist or pharmacy violated state or federal law.

AB68,1543,14 (e) The reduction is permitted in a contract between a pharmacy and a pharmacy benefit manager and is related to a quality program.

AB68,1543,15 (6) Audits of pharmacies or pharmacists. (a) Definitions. In this subsection:

AB68,1543,18 1. “Audit” means a review of the accounts and records of a pharmacy or pharmacist by or on behalf of an entity that finances or reimburses the cost of health care services or prescription drugs.

AB68,1543,22 2. “Entity” means a defined network plan, as defined in s. 609.01 (1b), insurer, self-insured health plan, or pharmacy benefit manager or a person acting on behalf of a defined network plan, insurer, self-insured health plan, or pharmacy benefit manager.

AB68,1543,23 3. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB68,1543,25 (b) Procedures. An entity conducting an on-site or desk audit of pharmacist or pharmacy records shall do all of the following:

AB68,1544,3 1. 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.

AB68,1544,6 2. Refrain from auditing a pharmacist or pharmacy within the first 5 business days of a month unless the pharmacist or pharmacy consents to an audit during that time.

AB68,1544,8 3. If the audit involves clinical or professional judgment, conduct the audit by or in consultation with a pharmacist licensed in any state.

AB68,1544,10 4. Limit the audit review to no more than 250 separate prescriptions. For purposes of this subdivision, a refill of a prescription is not a separate prescription.