WI SB203

Requires pharmacy benefit managers (PBMs) to pay pharmacies a professional dispensing fee at least equal to Wisconsin Medicaid rates, prohibits PBMs from charging pharmacies fees such as claim-processing or network-participation fees, and mandates payment to pharmacies within 30 days of claim submission.

Establishes PBM fiduciary duty to health plan sponsors and requires annual disclosure of profits from owned pharmacies, payments to brokers, amounts retained from drug manufacturers, and fees collected from network pharmacies.

Prohibits PBMs from discriminating against 340B covered entities by requiring equal reimbursement rates, banning post-adjudication fees, and preventing restrictions on 340B drug dispensing methods or network access.

Requires health insurers and PBMs to apply amounts paid for brand name prescription drugs toward cost-sharing requirements and out-of-pocket maximums, and extends formulary change notice requirements from 30 to 90 days with drug removal only permitted at coverage renewal.

Mandates that PBMs allow any licensed pharmacy to join their networks under the same terms, prohibits incentivizing patients to use specific pharmacies, bans "gag clauses" preventing pharmacists from informing patients about drug costs, and prohibits retaliation against pharmacies for reporting violations.