Wisconsin Gov. Tony Evers (D) is pushing for passage of a package of 13 “Less for Rx” bills to control prescription drug costs, including one to eliminate payer and pharmacy benefit manager (PBM) discrimination against certain 340B covered entities.
The Less for Rx package’s 340B-related bill would apply only to federally qualified health centers, critical access hospitals, federal Ryan White HIV/AIDS program grantees, and these covered entities’ in-house and contract pharmacies. It would bar reimbursing them for 340B-purchased drugs at a lower rate “than that paid to for the same drug to pharmacies that are similar in prescription volume. Fees, chargebacks, or other adjustments assessed against covered entities because they participate in the 340B program would also be prohibited.
Along with the 340B anti-discrimination provision, the group of bills would also create a drug affordability review board that would establish spending targets for public entities and establish price limits; empower the state to study and develop a drug purchasing entity that would be used to leverage lower costs; and require health insurers to apply manufacturer discounts and coupons toward annual out-of-pocket costs for individual enrollees. Co-payments for enrollees in BadgerCare, the state’s Medicaid program, would be eliminated.
Community clinics that treat low-income and uninsured patients—many of which are covered entities—would also receive an additional $4 million in funding over the next two years.
Sixteen states have passed laws since 2019 addressing pharmacy benefit manager (PBM) discrimination against 340B covered entities, health center advocates say. The Wisconsin bill is unique since it appears not to protect most of the 340B hospitals in the state. State and hospital groups are likely to advocate that these facilities be added to the bill.
Last month, U.S. Reps. David McKinley (R-W.Va.) and Abigail Spanberger (D-Va.) introduced bipartisan legislation to prohibit pharmacy benefit managers (PBMs) and other third-party payers from paying 340B providers below-market rates or engaging in other perceived discriminatory contracting practices.
“It’s time for bold solutions and comprehensive reform that increases transparency and accountability, reduces out-of-pocket expenses, and tackles this issue head on,” Evers said in a statement.
The legislative package has the support of Wisconsin Insurance Commissioner Mark Afable. “I am glad to see those proposals continue to move forward in this legislative package so that every Wisconsinite can get the medications they need,” he said.
Whether the bill passes the Wisconsin Legislature remains to be seen. The package was crafted by two Democrats, Rep. Lisa Subeck and Sen. Jon Erpenbach. It does not appear to have any public support from the Republican side of the aisle.
Republicans have large majorities in both the Senate and Assembly. They also quashed similar proposals that Evers had introduced in the state’s last budget bill, which he signed into law last month.
In a press conference to announce the legislative package, Evers said he did not intend to call a special session of the legislature to debate the proposals. Instead, he hopes it will “percolate through the legislature” when it reconvenes this fall.