Definitions.

“Pharmacy benefits management” means the administration or management of prescription drug benefits provided by an insurer or other 3rd party, including the performance of any of the following services: 1. Dispensation of prescription drugs by mail. 2. Claims processing, retail network management, or payment of claims to pharmacies for prescription drugs dispensed to individuals. 3. Clinical formulary development and management services. 4. Rebate contracting and administration. 5. Conduct of patient compliance, therapeutic intervention, generic substitution, and disease management programs.

“Pharmacy benefits manager” means an entity that performs pharmacy benefits management.

“Recipient” means an individual or his or her spouse or dependent who has been or is one of the following: 1. A recipient of medical assistance or of a program administered under medical assistance under a waiver of federal Medicaid laws. 2. An enrollee of family care. 3. A recipient of the Badger Care health care program. 4. An individual who receives benefits under s. 49.68, 49.683, or 49.685. 5. A participant in the program of prescription drug assistance for elderly persons under s. 49.688. 6. A woman who receives services that are reimbursed under s. 255.06.

“Third party” means an entity that by statute, rule, contract, or agreement is responsible for payment of a claim for a health care item or service, including any of the following: 1. An insurer. 2. An employee benefit plan, as defined in 29 USC 1002 (3). 3. A service benefit plan, as defined in 5 USC 8903 (1). 4. A pharmacy benefits manager. 5. A group health plan, as defined in 29 USC 1191b (a) (1), including a self-insured plan. 6. The issuer of a disability insurance policy. 7. An entity that administers benefits on behalf of another risk-bearing 3rd party, including a 3rd-party administrator, a fiscal intermediary, or a managed care contractor.