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2019 - 2020 LEGISLATURE
February 18, 2020 - Offered by Representatives Anderson, Kolste, Riemer,
Subeck, Vining, Billings, Hintz, Hesselbein, Spreitzer, Doyle, Shankland,
B. Meyers, L. Myers, Pope, Hebl, Stubbs, Zamarripa, Emerson, Brostoff,
Cabrera, Vruwink, Haywood, Ohnstad, Goyke, C. Taylor, Sargent,
Considine, Neubauer and Fields.
AB114-ASA1-AA2,1,11 At the locations indicated, amend the substitute amendment as follows:
AB114-ASA1-AA2,1,2 21. Page 7, line 19: after that line insert:
AB114-ASA1-AA2,1,3 3 Section 11t. 609.83 of the statutes is amended to read:
AB114-ASA1-AA2,1,6 4609.83 Coverage of drugs and devices. Limited service health
5organizations, preferred provider plans, and defined network plans are subject to ss.
6632.853 and 632.895 (6) (b) and (16t).”.
AB114-ASA1-AA2,1,8 72. Page 7, line 20: after “statutes" insert “, as affected by 2019 Wisconsin Act
8.... (this act),".
AB114-ASA1-AA2,1,9 93. Page 7, line 23: after “632.895" insert “(6) (b) and".
AB114-ASA1-AA2,1,10 104. Page 17, line 15: after that line insert:
AB114-ASA1-AA2,1,11 11 Section 21f. 632.895 (6) (title) of the statutes is amended to read:
1632.895 (6) (title) Equipment and supplies for treatment of diabetes; insulin .
AB114-ASA1-AA2,21g 2Section 21g. 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and
3amended to read:
AB114-ASA1-AA2,2,144 632.895 (6) (a) Every disability insurance policy which provides coverage of
5expenses incurred for treatment of diabetes shall provide coverage for expenses
6incurred by the installation and use of an insulin infusion pump, coverage for all
7other equipment and supplies, including insulin or any other prescription
8medication, used in the treatment of diabetes, and coverage of diabetic
9self-management education programs. Coverage Except as provided in par. (b),
required under this subsection shall be subject to the same exclusions,
11limitations, deductibles, and coinsurance provisions of the policy as other covered
12expenses, except that insulin infusion pump coverage may be limited to the purchase
13of one pump per year and the insurer may require the insured to use a pump for 30
14days before purchase.
AB114-ASA1-AA2,21h 15Section 21h. 632.895 (6) (b) of the statutes is created to read:
AB114-ASA1-AA2,2,1616 632.895 (6) (b) 1. In this paragraph:
AB114-ASA1-AA2,2,1817 a. “Cost sharing” means the total of any deductible, copayment, or coinsurance
18amounts imposed on a person covered under a policy or plan.
AB114-ASA1-AA2,2,2519 b. “Rebate” means a price concession that accrues directly or indirectly in the
20event of an increase in the wholesale acquisition cost of a prescription drug above a
21specified threshold; a negotiated price concession that may accrue directly or
22indirectly from a drug manufacturer, pharmacy, or another party in the prescription
23drug sale transaction; or a price concession given to an insurer or plan sponsor of a
24self-insured plan to reduce the liability of the insurer or sponsor for the prescription
1c. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB114-ASA1-AA2,3,42 2. Every disability insurance policy and self-insured health plan that covers
3insulin and that imposes cost sharing on prescription drugs may not impose cost
4sharing on insulin in an amount that exceeds the lesser of the following:
AB114-ASA1-AA2,3,55 a. One hundred dollars for a one-month supply of insulin.
AB114-ASA1-AA2,3,106 b. The greater of the amount that is 125 percent of the cost to the policy or plan
7of insulin or the amount generated by subtracting 51 percent of the total rebates
8received by the policy or plan from the cost-sharing amount that would be charged
9to a covered person for insulin if it is treated as any other prescription drug under
10the policy or plan.
AB114-ASA1-AA2,3,1511 3. Nothing in this paragraph prohibits a disability insurance policy or
12self-insured health plan from imposing cost sharing on insulin in an amount less
13than the amount specified under subd. 2. Nothing in this paragraph requires a
14disability insurance policy or self-insured health plan to impose any cost sharing on
AB114-ASA1-AA2,3,1816 4. Nothing in this paragraph requires a disability insurance policy or a
17self-insured health plan to reveal the amount of rebates received or any information
18that is protected as a trade secret.”.
AB114-ASA1-AA2,3,19 195. Page 25, line 6: after that line insert:
AB114-ASA1-AA2,4,7 20“(2) Investigation on insulin pricing. The commissioner of insurance shall
21investigate the pricing of prescription insulin that is made available to residents of
22this state to ensure adequate consumer protection and determine whether
23additional consumer protection is needed. The commissioner of insurance as part of
24the investigation shall compile and analyze information concerning the

1organization, business practices, pricing information, data, reports, and other
2information from companies engaged in the manufacture or sale of prescription
3insulin, including any publicly available information related to prescription drug
4pricing, that the commissioner finds necessary to conduct the investigation under
5this subsection. The commissioner of insurance may not compel any person or
6business to provide proprietary information or trade secrets for purposes of this
AB114-ASA1-AA2,4,118 (3) Report on insulin pricing. By January 1, 2021, the commissioner of
9insurance shall prepare and submit to the governor and, under s. 13.172, to the
10legislature a report that contains all of the following based on the investigation
11conducted under sub. (2):
AB114-ASA1-AA2,4,1312 (a) A summary of insulin pricing practices and variables that contribute to the
13pricing of disability insurance policies.
AB114-ASA1-AA2,4,1514 (b) Policy recommendations to control and prevent overpricing of prescription
15insulin made available to residents of this state.
AB114-ASA1-AA2,4,1716 (c) Any recommendations for changes to the laws of this state to prevent
17deceptive practices related to the sale or pricing of prescription insulin.
AB114-ASA1-AA2,4,1918 (d) Any other information that the commissioner of insurance determines is
19helpful to understanding the pricing or sale of insulin or other prescription drugs.”.
AB114-ASA1-AA2,4,21 206. Page 25, line 10: delete “subsection." and substitute “subsection, except as
AB114-ASA1-AA2,5,2 22(a) For policies and plans containing provisions inconsistent with s. 632.895
23(6) (b), the treatment of ss. 609.83 (by Section 11t) and 632.895 (6) (title) and (b) and
24the renumbering and amendment of s. 632.895 (6) first apply to policy or plan years

1beginning on January 1 of the year following the year in which this paragraph takes
2effect, except as provided in par. (b).
AB114-ASA1-AA2,5,8 3(b) For policies and plans that are affected by a collective bargaining agreement
4containing provisions inconsistent with s. 632.895 (6) (b), the treatment of ss. 609.83
5(by Section 11t) and 632.895 (6) (title) and (b) and the renumbering and amendment
6of s. 632.895 (6) first apply to policy or plan years beginning on the effective date of
7this paragraph or on the day on which the collective bargaining agreement is newly
8established, extended, modified, or renewed, whichever is later.”.
AB114-ASA1-AA2,5,10 97. Page 25, line 13: delete “enactment." and substitute “enactment, except as
AB114-ASA1-AA2,5,14 11(a) The treatment of ss. 609.83 (by Section 11t) and 632.895 (6) (title) and (b),
12the renumbering and amendment of s. 632.895 (6), and Sections 45 (2) and (3) and
1346 (1) (a) and (b) of this act take effect on the first day of the 4th month beginning
14after publication.”.
This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.