WAUSAU — Gov. Tony Evers today visited the Bridge Community Clinic in Wausau to tour their vaccine program and highlight his Badger Bounceback agenda’s investments in affordable and accessible healthcare. The governor also signed Senate Bill 3, which will increase transparency in the prescription drug supply chain by creating licensing and practice requirements for pharmacy benefit managers (PBMs) in the state of Wisconsin.
“The prescription drug supply chain can be a confusing and opaque system that often sends folks jumping through hoops just to access their life-saving medications. That’s just wrong. Period,” said Gov. Evers. “PBMs play a critical role in the drug supply chain and determining out-of-pocket costs for patients, but frankly, they don’t have a lot of oversight or accountability. This bill takes important steps forward in increasing transparency and looking out for Wisconsin’s most vulnerable.
“I also want to thank former State Representative Deb Kolste for her good work on this bill. While she couldn’t join me for the bill signing today, she championed this bill in the Legislature for years and I don’t believe it would be on my desk today if it weren’t for her early and persistent advocacy for this bill and for the people of Wisconsin.”
Former State Representative Deb Kolste served in the Wisconsin State Legislature representing Wisconsin’s 44th Assembly District since 2013. She introduced this bill over multiple legislative sessions before retiring from the Legislature in 2020.
“Pharmacy benefit managers play an outsized role in patient access to medications and in the health and wellness of our state,” said former State Representative Deb Kolste (D-Janesville). “Despite their ubiquity and importance to prescription drugs, there is virtually no regulation of these businesses in Wisconsin. Thankfully, that changes today. This is an important consumer protection and first step in increasing transparency in prescription drug pricing.”
Senate Bill 3, now Wisconsin Act 9, among other provisions:
- Requires a PBM to be licensed by the Office of the Commissioner of Insurance (OCI);
- Requires a PBM to submit an annual report to the OCI regarding the amount of rebates received from the drug manufacturer and what percentage of that rebate was retained by the PBM and not passed down to consumers as cost savings;
- Empowers OCI to require reports or conduct examinations of licensees to prevent misconduct and ensure consumer protections;
- Prohibits PBM gag clauses that prevent pharmacists from informing patients of more affordable alternative options;
- Requires two-weeks notice from a PBM before an audit of a pharmacy and prohibits retroactive claim reductions or denials by PBMs with certain exceptions;
- Prohibits a PBM from charging a copay greater than the amount that the pharmacy would charge a patient not using insurance;
- Requires 30 days written notice of any drug formulary changes that removes the individual’s prescription drug from the formulary or that reassigns the drug to a benefit tier with a higher deductible, copayment, or coinsurance; and
- Ensures pharmacies post signage informing customers of legal drug substitutions and how to find the FDA’s approved list.