SB 100 / AB 114 Will Put Wisconsin Patients and Taxpayers Ahead of PBM Profits
SB 100 by Sen. Jon Erpenbach and AB 114 by Rep. Michael Schraa will enable Wisconsin to more effectively monitor pharmacy benefit managers (PBMs) and establish certain price transparency requirements that will ultimately protect patients, consumers, taxpayers, health plans and pharmacies from overpaying for prescriptions.
SB 100 / AB 114 also:
Requires PBMs to register with the State of Wisconsin in order to do business, ensuring a fair system of regulation and oversight similar to what's currently required of insurance companies doing business in Wisconsin
Allows health plan sponsors to know the amounts paid to pharmacies, which in turn allows the health plan to know the percentage of spread included in the amount they pay to PBMs
Prevents PBMs from charging patients a higher copayment than the cash price of the drug and disallows the use of contractual “gag clauses” -- freeing pharmacists to openly share information with patients about the availability of the lower-cost alternatives to a prescribed medication
Limits patients’ cost share covered under a health insurance policy or self-insured governmental health plan at the pharmacy counter, and prohibits PBMs from requiring patients to pay an increased cost share for a newly-prescribed drug or device
Allows pharmacies a fair and reasonable appeals process for any reimbursements which fall below drug acquisition cost
Under SB 100 /AB 114 Wisconsin patients, taxpayers and pharmacies are free to know the facts about how their prescriptions are priced and who is profiting in the prescription drug supply chain. SB 100 / AB 114 is the start of a new era of transparency that will provide some much-needed relief at - and behind - the pharmacy counter!