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AB56-SA2,73,3
1(e) “Manufacturer” has the meaning given in s. 450.01 (12). “Manufacturer”
2does not include an entity that is engaged only in the dispensing, as defined in s.
3450.01 (7), of a brand-name drug or a generic drug.
AB56-SA2,73,74 (f) “Manufacturer-sponsored assistance program” means a program offered by
5a manufacturer or an intermediary under contract with a manufacturer through
6which a brand-name drug or a generic drug is provided to a patient at no charge or
7at a discount.
AB56-SA2,73,118 (g) “Margin” means, for a covered hospital, the difference between the net cost
9of a brand-name drug or generic drug covered under the federal drug-pricing
10program under 42 USC 256b and the net payment by the covered hospital for that
11brand-name drug or generic drug.
AB56-SA2,73,1312 (h) “Net payment” means the amount paid for a brand-name drug or generic
13drug after all discounts and rebates have been applied.
AB56-SA2,73,1414 (i) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
AB56-SA2,73,1815 (j) “Wholesale acquisition cost” means the most recently reported
16manufacturer list or catalog price for a brand-name drug or a generic drug available
17to wholesalers or direct purchasers in the United States, before application of
18discounts, rebates, or reductions in price.
AB56-SA2,73,24 19(2) Price increase or introduction notice; justification report. (a) A
20manufacturer shall notify the commissioner if it is increasing the wholesale
21acquisition cost of a brand-name drug on the market in this state by more than 10
22percent or by more than $10,000 during any 12-month period or if it intends to
23introduce to market in this state a brand-name drug that has an annual wholesale
24acquisition cost of $30,000 or more.
AB56-SA2,74,4
1(b) A manufacturer shall notify the commissioner if it is increasing the
2wholesale acquisition cost of a generic drug by more than 25 percent or by more than
3$300 during any 12-month period or if it intends to introduce to market a generic
4drug that has an annual wholesale acquisition cost of $3,000 or more.
AB56-SA2,74,105 (c) The manufacturer shall provide the notice under par. (a) or (b) in writing
6at least 30 days before the planned effective date of the cost increase or drug
7introduction with a justification that includes all documents and research related to
8the manufacturer's selection of the cost increase or introduction price and a
9description of life cycle management, market competition and context, and
10estimated value or cost-effectiveness of the product.
AB56-SA2,74,14 11(3) Net prices paid by pharmacy benefit managers. By March 1 annually, the
12manufacturer shall report to the commissioner the value of price concessions,
13expressed as a percentage of the wholesale acquisition cost, provided to each
14pharmacy benefit manager for each drug sold in this state.
AB56-SA2,74,19 15(4) Rebates and price concessions. By March 1 annually, each pharmacy
16benefit manager shall report to the commissioner the amount received from
17manufacturers as drug rebates and the value of price concessions, expressed as a
18percentage of the wholesale acquisition cost, provided by manufacturers for each
19drug.
AB56-SA2,74,24 20(5) Hospital margin spending. By March 1 annually, each covered hospital
21operating in this state shall report to the commissioner the per unit margin for each
22drug covered under the federal drug pricing program under 42 USC 256b dispensed
23in the previous year multiplied by the number of units dispensed at that margin and
24how the margin revenue was used.
AB56-SA2,75,4
1(6) Manufacturer-sponsored assistance programs. By March 1 annually,
2each manufacturer shall provide the commissioner with a description of each
3manufacturer-sponsored patient assistance program in effect during the previous
4year that includes all of the following:
AB56-SA2,75,55 (a) The terms of the programs.
AB56-SA2,75,66 (b) The number of prescriptions provided to state residents under the program.
AB56-SA2,75,87 (c) The total market value of assistance provided to residents of this state under
8the program.
AB56-SA2,75,13 9(7) Certification and penalties for noncompliance. Each manufacturer and
10covered hospital that is required to report under this section shall certify each report
11as accurate under the penalty of perjury. A manufacturer or covered hospital that
12fails to submit a report required under this section is subject to a forfeiture of no more
13than $10,000 each day the report is overdue.
AB56-SA2,75,17 14(8) Hearing and public reporting. (a) The commissioner shall publicly post
15manufacturer price justification documents and covered hospital documentation of
16how each hospital spends the margin revenue. The commissioner shall keep any
17trade secret or proprietary information confidential.
AB56-SA2,75,2518 (b) The commissioner shall analyze data collected under this section and
19publish annually a report on emerging trends in prescription prices and price
20increases, and shall annually conduct a public hearing based on the analysis under
21this paragraph. The report under this paragraph shall include analysis of
22manufacturer prices and price increases, analysis of hospital-specific margins and
23how that revenue is spent or allocated on a hospital-specific basis, and analysis of
24how pharmacy benefit manager discounts and net costs compare to retail prices paid
25by patients.
AB56-SA2,76,8
1(9) Allowing cost disclosure to insured. The commissioner shall ensure that
2every disability insurance policy that covers prescription drugs or biological products
3does not restrict a pharmacy or pharmacist that dispenses a prescription drug or
4biological product from informing and does not penalize a pharmacy or pharmacist
5for informing an insured under a policy of a difference between the negotiated price
6of, or copayment or coinsurance for, the drug or biological product under the policy
7and the price the insured would pay for the drug or biological product if the insured
8obtained the drug or biological product without using any health insurance coverage.
AB56-SA2,2097i 9Section 2097i. 632.895 (8) (d) of the statutes is amended to read:
AB56-SA2,76,1610 632.895 (8) (d) Coverage is required under this subsection despite whether the
11woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c), and
12(e), coverage under this subsection may only be subject to exclusions and limitations,
13including deductibles, copayments and restrictions on excessive charges, that are
14applied to other radiological examinations covered under the disability insurance
15policy. Coverage under this subsection may not be subject to any deductibles,
16copayments, or coinsurance.
AB56-SA2,2098i 17Section 2098i. 632.895 (13m) of the statutes is created to read:
AB56-SA2,76,1918 632.895 (13m) Preventive services. (a) In this section, “self-insured health
19plan” has the meaning given in s. 632.85 (1) (c).
AB56-SA2,76,2220 (b) Every disability insurance policy, except any disability insurance policy that
21is described in s. 632.745 (11) (b) 1. to 12., and every self-insured health plan shall
22provide coverage for all of the following preventive services:
AB56-SA2,76,2323 1. Mammography in accordance with sub. (8).
AB56-SA2,76,2524 2. Genetic breast cancer screening and counseling and preventive medication
25for adult women at high risk for breast cancer.
AB56-SA2,77,2
13. Papanicolaou test for cancer screening for women 21 years of age or older
2with an intact cervix.
AB56-SA2,77,43 4. Human papillomavirus testing for women who have attained the age of 30
4years but have not attained the age of 66 years.
AB56-SA2,77,55 5. Colorectal cancer screening in accordance with sub. (16m).
AB56-SA2,77,86 6. Annual tomography for lung cancer screening for adults who have attained
7the age of 55 years but have not attained the age of 80 years and who have health
8histories demonstrating a risk for lung cancer.
AB56-SA2,77,109 7. Skin cancer screening for individuals who have attained the age of 10 years
10but have not attained the age of 22 years.
AB56-SA2,77,1211 8. Counseling for skin cancer prevention for adults who have attained the age
12of 18 years but have not attained the age of 25 years.
AB56-SA2,77,1413 9. Abdominal aortic aneurysm screening for men who have attained the age of
1465 years but have not attained the age of 75 years and who have ever smoked.
AB56-SA2,77,1715 10. Hypertension screening for adults and blood pressure testing for adults, for
16children under the age of 3 years who are at high risk for hypertension, and for
17children 3 years of age or older.
AB56-SA2,77,1918 11. Lipid disorder screening for minors 2 years of age or older, adults 20 years
19of age or older at high risk for lipid disorders, and all men 35 years of age or older.
AB56-SA2,77,2220 12. Aspirin therapy for cardiovascular health for adults who have attained the
21age of 55 years but have not attained the age of 80 years and for men who have
22attained the age of 45 years but have not attained the age of 55 years.
AB56-SA2,77,2423 13. Behavioral counseling for cardiovascular health for adults who are
24overweight or obese and who have risk factors for cardiovascular disease.
AB56-SA2,77,2525 14. Type II diabetes screening for adults with elevated blood pressure.
AB56-SA2,78,2
115. Depression screening for minors 11 years of age or older and for adults when
2follow-up supports are available.
AB56-SA2,78,43 16. Hepatitis B screening for minors at high risk for infection and adults at high
4risk for infection.
AB56-SA2,78,65 17. Hepatitis C screening for adults at high risk for infection and one-time
6hepatitis C screening for adults born in any year from 1945 to 1965.
AB56-SA2,78,107 18. Obesity screening and management for all minors and adults with a body
8mass index indicating obesity, counseling and behavioral interventions for obese
9minors who are 6 years of age or older, and referral for intervention for obesity for
10adults with a body mass index of 30 kilograms per square meter or higher.
AB56-SA2,78,1211 19. Osteoporosis screening for all women 65 years of age or older and for women
12at high risk for osteoporosis under the age of 65 years.
AB56-SA2,78,1313 20. Immunizations in accordance with sub. (14).
AB56-SA2,78,1614 21. Anemia screening for individuals 6 months of age or older and iron
15supplements for individuals at high risk for anemia and who have attained the age
16of 6 months but have not attained the age of 12 months.
AB56-SA2,78,1817 22. Fluoride varnish for prevention of tooth decay for minors at the age of
18eruption of their primary teeth.
AB56-SA2,78,2019 23. Fluoride supplements for prevention of tooth decay for minors 6 months of
20age or older who do not have fluoride in their water source.
AB56-SA2,78,2121 24. Gonorrhea prophylaxis treatment for newborns.
AB56-SA2,78,2222 25. Health history and physical exams for prenatal visits and for minors.
AB56-SA2,78,2423 26. Length and weight measurements for newborns and height and weight
24measurements for minors.
AB56-SA2,79,2
127. Head circumference and weight-for-length measurements for newborns
2and minors who have not attained the age of 3 years.
AB56-SA2,79,33 28. Body mass index for minors 2 years of age or older.
AB56-SA2,79,54 29. Blood pressure measurements for minors 3 years of age or older and a blood
5pressure risk assessment at birth.
AB56-SA2,79,76 30. Risk assessment and referral for oral health issues for minors who have
7attained the age of 6 months but have not attained the age of 7 years.
AB56-SA2,79,98 31. Blood screening for newborns and minors who have not attained the age of
92 months.
AB56-SA2,79,1010 32. Screening for critical congenital health defects for newborns.
AB56-SA2,79,1111 33. Lead screenings in accordance with sub. (10).
AB56-SA2,79,1312 34. Metabolic and hemoglobin screening and screening for phenylketonuria,
13sickle cell anemia, and congenital hypothyroidism for minors including newborns.
AB56-SA2,79,1514 35. Tuberculin skin test based on risk assessment for minors one month of age
15or older.
AB56-SA2,79,1716 36. Tobacco counseling and cessation interventions for individuals who are 5
17years of age or older.
AB56-SA2,79,1918 37. Vision and hearing screening and assessment for minors including
19newborns.
AB56-SA2,79,2120 38. Sexually transmitted infection and human immunodeficiency virus
21counseling for sexually active minors.
AB56-SA2,79,2422 39. Risk assessment for sexually transmitted infection for minors who are 10
23years of age or older and screening for sexually transmitted infection for minors who
24are 16 years of age or older.
AB56-SA2,79,2525 40. Alcohol misuse screening and counseling for minors 11 years of age or older.
AB56-SA2,80,2
141. Autism screening for minors who have attained the age of 18 months but
2have not attained the age of 25 months.
AB56-SA2,80,33 42. Developmental screening and surveillance for minors including newborns.
AB56-SA2,80,44 43. Psychosocial and behavioral assessment for minors including newborns.
AB56-SA2,80,65 44. Alcohol misuse screening and counseling for pregnant adults and a risk
6assessment for all adults.
AB56-SA2,80,87 45. Fall prevention and counseling and preventive medication for fall
8prevention for community-dwelling adults 65 years of age or older.
AB56-SA2,80,99 46. Screening and counseling for intimate partner violence for adult women.
AB56-SA2,80,1210 47. Well-woman visits for women who have attained the age of 18 years but
11have not attained the age of 65 years and well-woman visits for recommended
12preventive services, preconception care, and prenatal care.
AB56-SA2,80,1413 48. Counseling on, consultations with a trained provider on, and equipment
14rental for breastfeeding for pregnant and lactating women.
AB56-SA2,80,1515 49. Folic acid supplement for adult women with reproductive capacity.
AB56-SA2,80,1616 50. Iron deficiency anemia screening for pregnant and lactating women.
AB56-SA2,80,1817 51. Preeclampsia preventive medicine for pregnant adult women at high risk
18for preeclampsia.
AB56-SA2,80,2019 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high
20risk for miscarriage, preeclampsia, or clotting disorders.
AB56-SA2,80,2121 53. Screenings for hepatitis B and bacteriuria for pregnant women.
AB56-SA2,80,2322 54. Screening for gonorrhea for pregnant and sexually active females 24 years
23of age or younger and females older than 24 years of age who are at risk for infection.
AB56-SA2,81,3
155. Screening for chlamydia for pregnant and sexually active females 24 years
2of age and younger and females older than 24 years of age who are at risk for
3infection.
AB56-SA2,81,54 56. Screening for syphilis for pregnant women and adults who are at high risk
5for infection.
AB56-SA2,81,86 57. Human immunodeficiency virus screening for adults who have attained the
7age of 15 years but have not attained the age of 66 years and individuals at high risk
8of infection who are younger than 15 years of age or older than 65 years of age.
AB56-SA2,81,99 58. All contraceptives and services in accordance with sub. (17).
AB56-SA2,81,1110 59. Any services not already specified under this paragraph having an A or B
11rating in current recommendations from the U.S. preventive services task force.
AB56-SA2,81,1412 60. Any preventive services not already specified under this paragraph that are
13recommended by the federal health resources and services administration's Bright
14Futures project.
AB56-SA2,81,1715 61. Any immunizations, not already specified under sub. (14), that are
16recommended and determined to be for routine use by the federal advisory
17committee on immunization practices.
AB56-SA2,81,2018 (c) Subject to par. (d), no disability insurance policy and no self-insured health
19plan may subject the coverage of any of the preventive services under par. (b) to any
20deductibles, copayments, or coinsurance under the policy or plan.
AB56-SA2,81,2421 (d) 1. If an office visit and a preventive service specified under par. (b) are billed
22separately by the health care provider, the disability insurance policy or self-insured
23health plan may apply deductibles to and impose copayments or coinsurance on the
24office visit but not on the preventive service.
AB56-SA2,82,3
12. If the primary reason for an office visit is not to obtain a preventive service,
2the disability insurance policy or self-insured health plan may apply deductibles to
3and impose copayments or coinsurance on the office visit.
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