LRB-4348/1
EKL:cdc&cjs
2021 - 2022 LEGISLATURE
September 2, 2021 - Introduced by Senators Erpenbach, Johnson, Agard,
Bewley,
Carpenter, Larson, Pfaff, Ringhand and Roys, cosponsored by
Representatives Subeck, Cabrera, Anderson, Baldeh, Cabral-Guevara,
Conley, Considine, Doyle, Emerson, Hesselbein, Hong, Milroy, L. Myers,
Neubauer, Pope, S. Rodriguez, Shankland, Shelton, Sinicki, Snodgrass,
Spreitzer, Stubbs, Vining and Vruwink. Referred to Committee on Health.
SB549,1,2
1An Act to create 632.865 (2m) of the statutes;
relating to: fiduciary and
2disclosure requirements on pharmacy benefit managers.
Analysis by the Legislative Reference Bureau
This bill imposes fiduciary and disclosure requirements on pharmacy benefit
managers. Pharmacy benefit managers contract with plans that provide
prescription drug benefits to administer that benefit for the plans. They also have
contracts with pharmacies and pay the pharmacies for providing the drugs to the
plan beneficiaries.
The bill provides that a pharmacy benefit manager owes a fiduciary duty to a
plan sponsor. The bill also requires that a pharmacy benefit manager annually
disclose all of the following information to the plan sponsor:
1. The indirect profit received by the pharmacy benefit manager from owning
a pharmacy or service provider.
2. Any payments made to a consultant or broker who works on behalf of the plan
sponsor.
3. From the amounts received from drug manufacturers, the amounts retained
by the pharmacy benefit manager that are related to the plan sponsor's claims or
bona fide service fees.
4. The amounts received from network pharmacies and the amount retained
by the pharmacy benefit manager.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB549,1
1Section
1. 632.865 (2m) of the statutes is created to read:
SB549,2,52
632.865
(2m) Fiduciary duty and disclosures to health benefit plan
3sponsors. (a) A pharmacy benefit manager owes a fiduciary duty to the health
4benefit plan sponsor to act according to the health benefit plan sponsor's instructions
5and in the best interests of the health benefit plan sponsor.
SB549,2,86
(b) A pharmacy benefit manager shall annually provide, no later than the date
7and using the method prescribed by the commissioner by rule, the health benefit plan
8sponsor all of the following information from the previous calendar year:
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1. The indirect profit received by the pharmacy benefit manager from owning
10any interest in a pharmacy or service provider.
SB549,2,1211
2. Any payment made by the pharmacy benefit manager to a consultant or
12broker who works on behalf of the health benefit plan sponsor.
SB549,2,1613
3. From the amounts received from all drug manufacturers, the amounts
14retained by the pharmacy benefit manager, and not passed through to the health
15benefit plan sponsor, that are related to the health benefit plan sponsor's claims or
16bona fide service fees.
SB549,2,2117
4. The amounts, including pharmacy access and audit recovery fees, received
18from all pharmacies that are in the pharmacy benefit manager's network or have a
19contract to be in the network and, from these amounts, the amount retained by the
20pharmacy benefit manager and not passed through to the health benefit plan
21sponsor.
