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AB68-ASA2-AA2,84,1717 6. Genetic information.
AB68-ASA2-AA2,84,1918 7. Evidence of insurability, including conditions arising out of acts of domestic
19violence.
AB68-ASA2-AA2,84,2020 8. Disability.
AB68-ASA2-AA2,85,221 (b) A short-term, limited duration plan may not require any individual, as a
22condition of enrollment or continued enrollment under the plan, to pay, on the basis
23of any health status-related factor under par. (a) with respect to the individual or a
24dependent of the individual, a premium or contribution or a deductible, copayment,
25or coinsurance amount that is greater than the premium or contribution or

1deductible, copayment, or coinsurance amount respectively for a similarly situated
2individual enrolled under the plan.
AB68-ASA2-AA2,85,4 3(4) Premium rate variation. A short-term, limited duration plan may vary
4premium rates for a specific plan based only on the following considerations:
AB68-ASA2-AA2,85,55 (a) Whether the policy or plan covers an individual or a family.
AB68-ASA2-AA2,85,66 (b) Rating area in the state, as established by the commissioner.
AB68-ASA2-AA2,85,97 (c) Age, except that the rate may not vary by more than 3 to 1 for adults over
8the age groups and the age bands shall be consistent with recommendations of the
9National Association of Insurance Commissioners.
AB68-ASA2-AA2,85,1010 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
AB68-ASA2-AA2,85,12 11(5) Annual and lifetime limits. A short-term, limited duration plan may not
12establish any of the following:
AB68-ASA2-AA2,85,1413 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent
14of an enrollee under the plan.
AB68-ASA2-AA2,85,1615 (b) Limits on the dollar value of benefits for an enrollee or a dependent of an
16enrollee under the plan for the initial or cumulative duration of the plan.
AB68-ASA2-AA2,412yj 17Section 412yj. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to
18read:
AB68-ASA2-AA2,86,219 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
20from the date of issue of the policy may be reduced or denied on the ground that a
21disease or physical condition existed prior to the effective date of coverage, unless the
22condition was excluded from coverage by name or specific description by a provision
23effective on the date of loss. This paragraph does not apply to a group health benefit
24plan, as defined in s. 632.745 (9), which is subject to s. 632.746 , a disability insurance

1policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s.
2632.85 (1) (c)
.
AB68-ASA2-AA2,86,83 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability
4commencing after 12 months from the date of issue of under an individual disability
5insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the
6ground that a disease or physical condition existed prior to the effective date of
7coverage, unless the condition was excluded from coverage by name or specific
8description by a provision effective on the date of the loss
.
AB68-ASA2-AA2,86,159 2. Except as provided in subd. 3., an An individual disability insurance policy,
10as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495
11(4) and (5), may not define a preexisting condition more restrictively than a condition
12that was present before the date of enrollment for the coverage, whether physical or
13mental, regardless of the cause of the condition, for which and regardless of whether
14medical advice, diagnosis, care, or treatment was recommended or received within
1512 months before the effective date of coverage
.
AB68-ASA2-AA2,412ym 16Section 412ym. 632.76 (2) (ac) 3. (intro.) of the statutes is amended to read:
AB68-ASA2-AA2,86,1917 632.76 (2) (ac) 3. (intro.) Except as the commissioner provides by rule under
18s. 632.7495 (5), all of the following apply to an individual disability insurance policy
19that is a short-term, limited duration policy subject to s. 632.7495 (4) and (5):
AB68-ASA2-AA2,412yp 20Section 412yp. 632.76 (2) (ac) 3. b. of the statutes is amended to read:
AB68-ASA2-AA2,87,221 632.76 (2) (ac) 3. b. The policy shall reduce the length of time during which a
22may not impose any preexisting condition exclusion may be imposed by the
23aggregate of the insured's consecutive periods of coverage under the insurer's
24individual disability insurance policies that are short-term policies subject to s.

1632.7495 (4) and (5). For purposes of this subd. 3. b., coverage periods are consecutive
2if there are no more than 63 days between the coverage periods
.
AB68-ASA2-AA2,412ys 3Section 412ys. 632.795 (4) (a) of the statutes is amended to read:
AB68-ASA2-AA2,87,154 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
5same policy form and for the same premium as it originally offered in the most recent
6enrollment period, subject only to the medical underwriting used in that enrollment
7period. Unless otherwise prescribed by rule, the insurer may apply deductibles,
8preexisting condition limitations, waiting periods , or other limits only to the extent
9that they would have been applicable had coverage been extended at the time of the
10most recent enrollment period and with credit for the satisfaction or partial
11satisfaction of similar provisions under the liquidated insurer's policy or plan. The
12insurer may exclude coverage of claims that are payable by a solvent insurer under
13insolvency coverage required by the commissioner or by the insurance regulator of
14another jurisdiction. Coverage shall be effective on the date that the liquidated
15insurer's coverage terminates.
AB68-ASA2-AA2,412yu 16Section 412yu. 632.796 of the statutes is created to read:
AB68-ASA2-AA2,87,18 17632.796 Drug cost report. (1) Definition. In this section, “disability
18insurance policy” has the meaning given in s. 632.895 (1) (a).
AB68-ASA2-AA2,87,24 19(2) Report required. Annually, at the time the insurer files its rate request
20with the commissioner, each insurer that offers a disability insurance policy that
21covers prescription drugs shall submit to the commissioner a report that identifies
22the 25 prescription drugs that are the highest cost to the insurer and the 25
23prescription drugs that have the highest cost increases over the 12 months before the
24submission of the report.
AB68-ASA2-AA2,412yw 25Section 412yw. 632.862 of the statutes is created to read:
AB68-ASA2-AA2,88,2
1632.862 Application of prescription drug payments. (1) Definitions. In
2this section:
AB68-ASA2-AA2,88,33 (a) “Brand name” has the meaning given in s. 450.12 (1) (a).
AB68-ASA2-AA2,88,44 (b) “Brand name drug” means any of the following:
AB68-ASA2-AA2,88,65 1. A prescription drug that contains a brand name and that has no generic
6equivalent.
AB68-ASA2-AA2,88,107 2. A prescription drug that contains a brand name and has a generic equivalent
8but for which the enrollee has received prior authorization from the insurer offering
9the disability insurance policy or the self-insured health plan or authorization from
10a physician to obtain the prescription drug under the policy or plan.
AB68-ASA2-AA2,88,1111 (c) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB68-ASA2-AA2,88,1212 (d) “Prescription drug” has the meaning given in s. 450.01 (20)
AB68-ASA2-AA2,88,1313 (e) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB68-ASA2-AA2,88,19 14(2) Application of discounts. A disability insurance policy that offers a
15prescription drug benefit or a self-insured health plan shall apply to any calculation
16of an out-of-pocket maximum and to any deductible of the policy or plan for an
17enrollee the amount that any discount provided by the manufacturer of a brand
18name drug reduces the cost sharing amount charged to an enrollee for that brand
19name drug.
AB68-ASA2-AA2,412yz 20Section 412yz. 632.8655 of the statutes is created to read:
AB68-ASA2-AA2,88,22 21632.8655 Prescription drug cost reporting. (1) Definitions. In this
22section:
AB68-ASA2-AA2,88,2423 (a) “Brand-name drug” means a prescription drug approved under 21 USC 355
24(b) or 42 USC 262.
AB68-ASA2-AA2,89,2
1(b) “Covered hospital” means an entity described in 42 USC 256b (a) (4) (L) to
2(N) that participates in the federal drug pricing program under 42 USC 256b.
AB68-ASA2-AA2,89,33 (c) “Generic drug” means a prescription drug approved under 21 USC 355 (j).
AB68-ASA2-AA2,89,74 (d) “Margin” means, for a covered hospital, the difference between the net cost
5of a brand-name drug or generic drug covered under the federal drug pricing
6program under 42 USC 256b and the net payment by the covered hospital for that
7brand-name drug or generic drug.
AB68-ASA2-AA2,89,98 (e) “Net payment” means the amount paid for a brand-name drug or generic
9drug after all discounts and rebates have been applied.
AB68-ASA2-AA2,89,14 10(2) Hospital margin spending. By March 1 annually, each covered hospital
11operating in this state shall report to the commissioner the per unit margin for each
12drug covered under the federal drug pricing program under 42 USC 256b dispensed
13in the previous year multiplied by the number of units dispensed at that margin and
14how the margin revenue was used.
AB68-ASA2-AA2,89,20 15(3) Public reporting. The commissioner shall publicly post covered hospital
16documentation of how each hospital spends the margin revenue. The commissioner
17shall analyze data collected under this section and publish annually a report
18including an analysis on hospital-specific margins and how that revenue is spent or
19allocated on a hospital-specific basis. The commissioner shall keep any trade secret
20or proprietary information confidential.
AB68-ASA2-AA2,412z 21Section 412z. 632.8665 of the statutes is created to read:
AB68-ASA2-AA2,89,23 22632.8665 Prescription drug cost reporting. (1) Definitions. In this
23section:
AB68-ASA2-AA2,89,2524 (a) “Brand-name drug” means a prescription drug approved under 21 USC 355
25(b) or 42 USC 262.
AB68-ASA2-AA2,90,1
1(b) “Generic drug” means a prescription drug approved under 21 USC 355 (j).
AB68-ASA2-AA2,90,42 (c) “Manufacturer” has the meaning given in s. 450.01 (12). “Manufacturer”
3does not include an entity that is engaged only in the dispensing, as defined in s.
4450.01 (7), of a brand-name drug or generic drug.
AB68-ASA2-AA2,90,85 (d) “Manufacturer-sponsored assistance program” means a program offered by
6a manufacturer or an intermediary under contract with a manufacturer through
7which a brand-name drug or generic drug is provided to a patient at no charge or at
8a discount.
AB68-ASA2-AA2,90,99 (e) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
AB68-ASA2-AA2,90,1310 (f) “Pharmacy services administrative organization” means an entity that
11provides contracting and other administrative services to a pharmacy to assist the
12pharmacy in interactions with a 3rd-party payer, pharmacy benefit manager,
13wholesale drug distributor, or other entity.
AB68-ASA2-AA2,90,1714 (g) “Wholesale acquisition cost” means the most recently reported
15manufacturer list or catalog price for a brand-name drug or generic drug available
16to wholesalers or direct purchasers in the United States, before application of
17discounts, rebates, or reductions in price.
AB68-ASA2-AA2,90,23 18(2) Price increase or introduction notice; justification report. (a) A
19manufacturer shall notify the commissioner if it is increasing the wholesale
20acquisition cost of a brand-name drug on the market in this state by more than 10
21percent or by more than $10,000 during any 12-month period or if it intends to
22introduce to market in this state a brand-name drug that has an annual wholesale
23acquisition cost of $30,000 or more.
AB68-ASA2-AA2,91,224 (b) A manufacturer shall notify the commissioner if it is increasing the
25wholesale acquisition cost of a generic drug by more than 25 percent or by more than

1$300 during any 12-month period or if it intends to introduce to market a generic
2drug that has an annual wholesale acquisition cost of $3,000 or more.
AB68-ASA2-AA2,91,83 (c) The manufacturer shall provide the notice under par. (a) or (b) in writing
4at least 30 days before the planned effective date of the cost increase or drug
5introduction with a justification that includes all documents and research related to
6the manufacturer's selection of the cost increase or introduction price and a
7description of life cycle management, market competition and context, and
8estimated value or cost-effectiveness of the product.
AB68-ASA2-AA2,91,12 9(3) Net prices paid by pharmacy benefit managers. By March 1 annually, the
10manufacturer shall report to the commissioner the value of price concessions,
11expressed as a percentage of the wholesale acquisition cost, provided to each
12pharmacy benefit manager for each drug sold in this state.
AB68-ASA2-AA2,91,17 13(4) Rebates and price concessions. By March 1 annually, each pharmacy
14benefit manager shall report to the commissioner the amount received from
15manufacturers as drug rebates and the value of price concessions, expressed as a
16percentage of the wholesale acquisition cost, provided by manufacturers for each
17drug.
AB68-ASA2-AA2,91,21 18(5) Manufacturer-sponsored assistance programs. By March 1 annually,
19each manufacturer shall provide the commissioner with a description of each
20manufacturer-sponsored patient assistance program in effect during the previous
21year that includes all of the following:
AB68-ASA2-AA2,91,2222 (a) The terms of the programs.
AB68-ASA2-AA2,91,2323 (b) The number of prescriptions provided to state residents under the program.
AB68-ASA2-AA2,91,2524 (c) The total market value of assistance provided to residents of this state under
25the program.
AB68-ASA2-AA2,92,3
1(6) Pharmacy services administrative organizations. By March 1 annually,
2each pharmacy services administrative organization shall report to the
3commissioner all of the following information:
AB68-ASA2-AA2,92,54 (a) The negotiated reimbursement rate of the 25 prescription drugs with the
5highest reimbursement rates during the previous year.
AB68-ASA2-AA2,92,76 (b) The 25 prescription drugs with the highest year-to-year change in
7reimbursement rate for the previous year.
AB68-ASA2-AA2,92,88 (c) The schedule of fees charged by the organization to pharmacies.
AB68-ASA2-AA2,92,14 9(7) Certification and penalties for noncompliance. Each manufacturer and
10pharmacy services administrative organization that is required to report under this
11section shall certify each report as accurate under the penalty of perjury. A
12manufacturer or pharmacy services administrative organization that fails to submit
13a report required under this section is subject to a forfeiture of no more than $10,000
14each day the report is overdue.
AB68-ASA2-AA2,92,17 15(8) Hearing and public reporting. (a) The commissioner shall publicly post
16manufacturer price justification documents. The commissioner shall keep any trade
17secret or proprietary information confidential.
AB68-ASA2-AA2,92,2318 (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 and analysis of how pharmacy benefit
23manager discounts and net costs compare to retail prices paid by patients.
AB68-ASA2-AA2,412zc 24Section 412zc. 632.868 of the statutes is created to read:
AB68-ASA2-AA2,92,25 25632.868 Insulin safety net programs. (1) Definitions. In this section:
AB68-ASA2-AA2,93,2
1(a) “Manufacturer" means a person engaged in the manufacturing of insulin
2that is self-administered on an outpatient basis.
AB68-ASA2-AA2,93,33 (b) “Navigator" has the meaning given in s. 628.90 (3).
AB68-ASA2-AA2,93,54 (c) “Patient assistance program” means a program established by a
5manufacturer under sub. (3) (a).
AB68-ASA2-AA2,93,66 (d) “Pharmacy" means an entity licensed under s. 450.06 or 450.065.
AB68-ASA2-AA2,93,97 (e) “Urgent need of insulin" means having less than a 7-day supply of insulin
8readily available for use and needing insulin in order to avoid the likelihood of
9suffering a significant health consequence.
AB68-ASA2-AA2,93,1110 (f) “Urgent need safety net program” means a program established by a
11manufacturer under sub. (2) (a).
AB68-ASA2-AA2,93,15 12(2) Urgent need safety net program. (a) Establishment of program. No later
13than July 1, 2022, each manufacturer shall establish an urgent need safety net
14program to make insulin available in accordance with this subsection to individuals
15who meet the eligibility requirements under par. (b).
AB68-ASA2-AA2,93,1716 (b) Eligible individual. An individual shall be eligible to receive insulin under
17an urgent need safety net program if all of the following conditions are met:
AB68-ASA2-AA2,93,1818 1. The individual is in urgent need of insulin.
AB68-ASA2-AA2,93,1919 2. The individual is a resident of this state.
AB68-ASA2-AA2,93,2020 3. The individual is not receiving public assistance under ch. 49.
AB68-ASA2-AA2,93,2521 4. The individual is not enrolled in prescription drug coverage through an
22individual or group health plan that limits the total cost sharing amount, including
23copayments, deductibles, and coinsurance, that an enrollee is required to pay for a
2430-day supply of insulin to no more than $75, regardless of the type or amount of
25insulin prescribed.
AB68-ASA2-AA2,94,2
15. The individual has not received insulin under an urgent need safety net
2program within the previous 12 months, except as allowed under par. (d).
AB68-ASA2-AA2,94,63 (c) Provision of insulin under an urgent need safety net program. 1. In order
4to receive insulin under an urgent need safety net program, an individual who meets
5the eligibility requirements under par. (b) shall provide a pharmacy with all of the
6following:
AB68-ASA2-AA2,94,107 a. A completed application, on a form prescribed by the commissioner that shall
8include an attestation by the individual, or the individual's parent or legal guardian
9if the individual is under the age of 18, that the individual meets all of the eligibility
10requirements under par. (b).
AB68-ASA2-AA2,94,1111 b. A valid insulin prescription.
AB68-ASA2-AA2,94,1412 c. A valid Wisconsin driver's license or state identification card. If the
13individual is under the age of 18, the individual's parent or legal guardian shall meet
14this requirement.
AB68-ASA2-AA2,94,2215 2. Upon receipt of the information described in subd. 1. a. to c., the pharmacist
16shall dispense a 30-day supply of the prescribed insulin to the individual. The
17pharmacy shall also provide the individual with the information sheet described in
18sub. (8) (b) 2. and the list of navigators described in sub. (8) (c). The pharmacy may
19collect a copayment, not to exceed $35, from the individual to cover the pharmacy's
20costs of processing and dispensing the insulin. The pharmacy shall notify the health
21care practitioner who issued the prescription no later than 72 hours after the insulin
22is dispensed.
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