Last Updated: September 26, 2022
In March 2021, Wisconsin legislators passed 2021 Wisconsin Act 9 which requires a pharmacy benefit manager (PBM) to obtain licensure from the Office of the Commissioner of Insurance. The act passed with bipartisan support and
most parts became effective on January 1, 2022. The goal of the increased oversight is to increase transparency, control costs, and protect consumers.
A PBM contracts to administer or manage prescription drug benefits for end payers, such as private insurers, cooperatives, and Medicare Part D plans.
OCI Bulletin:
2021 Wis. Act 9, New Law Update
Prescription drugs are a vital part of the health and wellbeing of Wisconsin residents. To control the cost of prescription medications, the Wisconsin Legislature passed a law in March 2021 requiring Pharmacy Benefit Managers (PBM) to be licensed and regulated by OCI. The goal of the oversight is to increase transparency, control costs, and protect consumers.
Learn all the ways OCI is working to increase access to health care and control costs at our Consumer's Health Section.
Licensing
A Pharmacy Benefit Manager (PBM) entity will need to determine if a PBM or Employee Benefit Plan Administrator (EBPA) license is required. A PBM entity that administers or manages pharmacy benefits for an insurer or another entity that provides prescription drug benefits to Wisconsin residents and does not collect premium or affect claims, must obtain a PBM license. If a PBM entity solicits or collects premiums, effects coverage, or settles claims the PBM must obtain an
EBPA license. Guidance and instruction on initial and renewal of licenses can be found by visiting Pharmacy Benefit Manager Licensing.
PBM Licensing
Transparency
Pharmacy Benefit Manager Transparency Reporting forms are required to be filed with the Office of the Commissioner of Insurance (OCI) by
June 1 of each year. Section 632.861 (7), Wis. Stat.
, requires that every pharmacy benefit manager submit to the commissioner a report that contains, from the previous calendar year, specific information identified in the statute for contracts held with pharmacies located in Wisconsin. The reports are to be considered a trade secret under the uniform trade secret act under s. 134.90, Wis. Stat.
- PBM Legal Name
- PBM DBA Name (if different than Legal Name)
- License Number
- Aggregate rebate amount received from all pharmaceutical manufacturers for reporting year
- Aggregate rebate amount retained and did not pass through to health benefit plan sponsors for reporting year
- Percentage of the aggregate rebate amount that is retained