Amendment SA2-AB56

AB56-SA2,73,3 (e) “Manufacturer” has the meaning given in s. 450.01 (12). “Manufacturer” does not include an entity that is engaged only in the dispensing, as defined in s. 450.01 (7), of a brand-name drug or a generic drug.

AB56-SA2,73,7 (f) “Manufacturer-sponsored assistance program” means a program offered by a manufacturer or an intermediary under contract with a manufacturer through which a brand-name drug or a generic drug is provided to a patient at no charge or at a discount.

AB56-SA2,73,11 (g) “Margin” means, for a covered hospital, the difference between the net cost of a brand-name drug or generic drug covered under the federal drug-pricing program under 42 USC 256b and the net payment by the covered hospital for that brand-name drug or generic drug.

AB56-SA2,73,13 (h) “Net payment” means the amount paid for a brand-name drug or generic drug after all discounts and rebates have been applied.

AB56-SA2,73,14 (i) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

AB56-SA2,73,18 (j) “Wholesale acquisition cost” means the most recently reported manufacturer list or catalog price for a brand-name drug or a generic drug available to wholesalers or direct purchasers in the United States, before application of discounts, rebates, or reductions in price.

AB56-SA2,73,24 (2) Price increase or introduction notice; justification report. (a) A manufacturer shall notify the commissioner if it is increasing the wholesale acquisition cost of a brand-name drug on the market in this state by more than 10 percent or by more than $10,000 during any 12-month period or if it intends to introduce to market in this state a brand-name drug that has an annual wholesale acquisition cost of $30,000 or more.

AB56-SA2,74,4 (b) A manufacturer shall notify the commissioner if it is increasing the wholesale acquisition cost of a generic drug by more than 25 percent or by more than $300 during any 12-month period or if it intends to introduce to market a generic drug that has an annual wholesale acquisition cost of $3,000 or more.

AB56-SA2,74,10 (c) The manufacturer shall provide the notice under par. (a) or (b) in writing at least 30 days before the planned effective date of the cost increase or drug introduction with a justification that includes all documents and research related to the manufacturer's selection of the cost increase or introduction price and a description of life cycle management, market competition and context, and estimated value or cost-effectiveness of the product.

AB56-SA2,74,14 (3) Net prices paid by pharmacy benefit managers. By March 1 annually, the manufacturer shall report to the commissioner the value of price concessions, expressed as a percentage of the wholesale acquisition cost, provided to each pharmacy benefit manager for each drug sold in this state.

AB56-SA2,74,19 (4) Rebates and price concessions. By March 1 annually, each pharmacy benefit manager shall report to the commissioner the amount received from manufacturers as drug rebates and the value of price concessions, expressed as a percentage of the wholesale acquisition cost, provided by manufacturers for each drug.

AB56-SA2,74,24 (5) Hospital margin spending. By March 1 annually, each covered hospital operating in this state shall report to the commissioner the per unit margin for each drug covered under the federal drug pricing program under 42 USC 256b dispensed in the previous year multiplied by the number of units dispensed at that margin and how the margin revenue was used.

AB56-SA2,75,4 (6) Manufacturer-sponsored assistance programs. By March 1 annually, each manufacturer shall provide the commissioner with a description of each manufacturer-sponsored patient assistance program in effect during the previous year that includes all of the following:

AB56-SA2,75,5 (a) The terms of the programs.

AB56-SA2,75,6 (b) The number of prescriptions provided to state residents under the program.

AB56-SA2,75,8 (c) The total market value of assistance provided to residents of this state under the program.

AB56-SA2,75,13 (7) Certification and penalties for noncompliance. Each manufacturer and covered hospital that is required to report under this section shall certify each report as accurate under the penalty of perjury. A manufacturer or covered hospital that fails to submit a report required under this section is subject to a forfeiture of no more than $10,000 each day the report is overdue.

AB56-SA2,75,17 (8) Hearing and public reporting. (a) The commissioner shall publicly post manufacturer price justification documents and covered hospital documentation of how each hospital spends the margin revenue. The commissioner shall keep any trade secret or proprietary information confidential.

AB56-SA2,75,25 (b) The commissioner shall analyze data collected under this section and publish annually a report on emerging trends in prescription prices and price increases, and shall annually conduct a public hearing based on the analysis under this paragraph. The report under this paragraph shall include analysis of manufacturer prices and price increases, analysis of hospital-specific margins and how that revenue is spent or allocated on a hospital-specific basis, and analysis of how pharmacy benefit manager discounts and net costs compare to retail prices paid by patients.

AB56-SA2,76,8 (9) Allowing cost disclosure to insured. The commissioner shall ensure that every disability insurance policy that covers prescription drugs or biological products does not restrict a pharmacy or pharmacist that dispenses a prescription drug or biological product from informing and does not penalize a pharmacy or pharmacist for informing an insured under a policy of a difference between the negotiated price of, or copayment or coinsurance for, the drug or biological product under the policy and the price the insured would pay for the drug or biological product if the insured obtained the drug or biological product without using any health insurance coverage.

AB56-SA2,2097i Section 2097i. 632.895 (8) (d) of the statutes is amended to read:

AB56-SA2,76,16 632.895 (8) (d) Coverage is required under this subsection despite whether the woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c), and (e), coverage under this subsection may only be subject to exclusions and limitations, including deductibles, copayments and restrictions on excessive charges, that are applied to other radiological examinations covered under the disability insurance policy. Coverage under this subsection may not be subject to any deductibles, copayments, or coinsurance.

AB56-SA2,2098i Section 2098i. 632.895 (13m) of the statutes is created to read:

AB56-SA2,76,19 632.895 (13m) Preventive services. (a) In this section, “self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB56-SA2,76,22 (b) Every disability insurance policy, except any disability insurance policy that is described in s. 632.745 (11) (b) 1. to 12., and every self-insured health plan shall provide coverage for all of the following preventive services:

AB56-SA2,76,23 1. Mammography in accordance with sub. (8).

AB56-SA2,76,25 2. Genetic breast cancer screening and counseling and preventive medication for adult women at high risk for breast cancer.

AB56-SA2,77,2 3. Papanicolaou test for cancer screening for women 21 years of age or older with an intact cervix.

AB56-SA2,77,4 4. Human papillomavirus testing for women who have attained the age of 30 years but have not attained the age of 66 years.

AB56-SA2,77,5 5. Colorectal cancer screening in accordance with sub. (16m).

AB56-SA2,77,8 6. Annual tomography for lung cancer screening for adults who have attained the age of 55 years but have not attained the age of 80 years and who have health histories demonstrating a risk for lung cancer.

AB56-SA2,77,10 7. Skin cancer screening for individuals who have attained the age of 10 years but have not attained the age of 22 years.

AB56-SA2,77,12 8. Counseling for skin cancer prevention for adults who have attained the age of 18 years but have not attained the age of 25 years.

AB56-SA2,77,14 9. Abdominal aortic aneurysm screening for men who have attained the age of 65 years but have not attained the age of 75 years and who have ever smoked.

AB56-SA2,77,17 10. Hypertension screening for adults and blood pressure testing for adults, for children under the age of 3 years who are at high risk for hypertension, and for children 3 years of age or older.

AB56-SA2,77,19 11. Lipid disorder screening for minors 2 years of age or older, adults 20 years of age or older at high risk for lipid disorders, and all men 35 years of age or older.

AB56-SA2,77,22 12. Aspirin therapy for cardiovascular health for adults who have attained the age of 55 years but have not attained the age of 80 years and for men who have attained the age of 45 years but have not attained the age of 55 years.

AB56-SA2,77,24 13. Behavioral counseling for cardiovascular health for adults who are overweight or obese and who have risk factors for cardiovascular disease.

AB56-SA2,77,25 14. Type II diabetes screening for adults with elevated blood pressure.

AB56-SA2,78,2 15. Depression screening for minors 11 years of age or older and for adults when follow-up supports are available.

AB56-SA2,78,4 16. Hepatitis B screening for minors at high risk for infection and adults at high risk for infection.

AB56-SA2,78,6 17. Hepatitis C screening for adults at high risk for infection and one-time hepatitis C screening for adults born in any year from 1945 to 1965.

AB56-SA2,78,10 18. Obesity screening and management for all minors and adults with a body mass index indicating obesity, counseling and behavioral interventions for obese minors who are 6 years of age or older, and referral for intervention for obesity for adults with a body mass index of 30 kilograms per square meter or higher.

AB56-SA2,78,12 19. Osteoporosis screening for all women 65 years of age or older and for women at high risk for osteoporosis under the age of 65 years.

AB56-SA2,78,13 20. Immunizations in accordance with sub. (14).

AB56-SA2,78,16 21. Anemia screening for individuals 6 months of age or older and iron supplements for individuals at high risk for anemia and who have attained the age of 6 months but have not attained the age of 12 months.

AB56-SA2,78,18 22. Fluoride varnish for prevention of tooth decay for minors at the age of eruption of their primary teeth.

AB56-SA2,78,20 23. Fluoride supplements for prevention of tooth decay for minors 6 months of age or older who do not have fluoride in their water source.

AB56-SA2,78,21 24. Gonorrhea prophylaxis treatment for newborns.

AB56-SA2,78,22 25. Health history and physical exams for prenatal visits and for minors.

AB56-SA2,78,24 26. Length and weight measurements for newborns and height and weight measurements for minors.

AB56-SA2,79,2 27. Head circumference and weight-for-length measurements for newborns and minors who have not attained the age of 3 years.

AB56-SA2,79,3 28. Body mass index for minors 2 years of age or older.

AB56-SA2,79,5 29. Blood pressure measurements for minors 3 years of age or older and a blood pressure risk assessment at birth.

AB56-SA2,79,7 30. Risk assessment and referral for oral health issues for minors who have attained the age of 6 months but have not attained the age of 7 years.

AB56-SA2,79,9 31. Blood screening for newborns and minors who have not attained the age of 2 months.

AB56-SA2,79,10 32. Screening for critical congenital health defects for newborns.

AB56-SA2,79,11 33. Lead screenings in accordance with sub. (10).

AB56-SA2,79,13 34. Metabolic and hemoglobin screening and screening for phenylketonuria, sickle cell anemia, and congenital hypothyroidism for minors including newborns.

AB56-SA2,79,15 35. Tuberculin skin test based on risk assessment for minors one month of age or older.

AB56-SA2,79,17 36. Tobacco counseling and cessation interventions for individuals who are 5 years of age or older.

AB56-SA2,79,19 37. Vision and hearing screening and assessment for minors including newborns.

AB56-SA2,79,21 38. Sexually transmitted infection and human immunodeficiency virus counseling for sexually active minors.

AB56-SA2,79,24 39. Risk assessment for sexually transmitted infection for minors who are 10 years of age or older and screening for sexually transmitted infection for minors who are 16 years of age or older.

AB56-SA2,79,25 40. Alcohol misuse screening and counseling for minors 11 years of age or older.

AB56-SA2,80,2 41. Autism screening for minors who have attained the age of 18 months but have not attained the age of 25 months.

AB56-SA2,80,3 42. Developmental screening and surveillance for minors including newborns.

AB56-SA2,80,4 43. Psychosocial and behavioral assessment for minors including newborns.

AB56-SA2,80,6 44. Alcohol misuse screening and counseling for pregnant adults and a risk assessment for all adults.

AB56-SA2,80,8 45. Fall prevention and counseling and preventive medication for fall prevention for community-dwelling adults 65 years of age or older.

AB56-SA2,80,9 46. Screening and counseling for intimate partner violence for adult women.

AB56-SA2,80,12 47. Well-woman visits for women who have attained the age of 18 years but have not attained the age of 65 years and well-woman visits for recommended preventive services, preconception care, and prenatal care.

AB56-SA2,80,14 48. Counseling on, consultations with a trained provider on, and equipment rental for breastfeeding for pregnant and lactating women.

AB56-SA2,80,15 49. Folic acid supplement for adult women with reproductive capacity.

AB56-SA2,80,16 50. Iron deficiency anemia screening for pregnant and lactating women.

AB56-SA2,80,18 51. Preeclampsia preventive medicine for pregnant adult women at high risk for preeclampsia.

AB56-SA2,80,20 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high risk for miscarriage, preeclampsia, or clotting disorders.

AB56-SA2,80,21 53. Screenings for hepatitis B and bacteriuria for pregnant women.

AB56-SA2,80,23 54. Screening for gonorrhea for pregnant and sexually active females 24 years of age or younger and females older than 24 years of age who are at risk for infection.

AB56-SA2,81,3 55. Screening for chlamydia for pregnant and sexually active females 24 years of age and younger and females older than 24 years of age who are at risk for infection.

AB56-SA2,81,5 56. Screening for syphilis for pregnant women and adults who are at high risk for infection.

AB56-SA2,81,8 57. Human immunodeficiency virus screening for adults who have attained the age of 15 years but have not attained the age of 66 years and individuals at high risk of infection who are younger than 15 years of age or older than 65 years of age.

AB56-SA2,81,9 58. All contraceptives and services in accordance with sub. (17).

AB56-SA2,81,11 59. Any services not already specified under this paragraph having an A or B rating in current recommendations from the U.S. preventive services task force.

AB56-SA2,81,14 60. Any preventive services not already specified under this paragraph that are recommended by the federal health resources and services administration's Bright Futures project.

AB56-SA2,81,17 61. Any immunizations, not already specified under sub. (14), that are recommended and determined to be for routine use by the federal advisory committee on immunization practices.

AB56-SA2,81,20 (c) Subject to par. (d), no disability insurance policy and no self-insured health plan may subject the coverage of any of the preventive services under par. (b) to any deductibles, copayments, or coinsurance under the policy or plan.

AB56-SA2,81,24 (d) 1. If an office visit and a preventive service specified under par. (b) are billed separately by the health care provider, the disability insurance policy or self-insured health plan may apply deductibles to and impose copayments or coinsurance on the office visit but not on the preventive service.

AB56-SA2,82,3 2. If the primary reason for an office visit is not to obtain a preventive service, the disability insurance policy or self-insured health plan may apply deductibles to and impose copayments or coinsurance on the office visit.