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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.
AB68-ASA2-AA2,95,523 3. A pharmacy that dispenses insulin under subd. 2. may submit to the
24manufacturer, or the manufacturer's vendor, a claim for payment that is in
25accordance with the national council for prescription drug programs' standards for

1electronic claims processing, except that no claim may be submitted if the
2manufacturer agrees to send the pharmacy a replacement of the same insulin in the
3amount dispensed. If the pharmacy submits an electronic claim, the manufacturer
4or vendor shall reimburse the pharmacy in an amount that covers the pharmacy's
5acquisition cost.
AB68-ASA2-AA2,95,76 4. A pharmacy that dispenses insulin under subd. 2. shall retain a copy of the
7application form described in subd. 1. a.
AB68-ASA2-AA2,95,148 (d) Eligibility of certain individuals. An individual who has applied for public
9assistance under ch. 49 but for whom a determination of eligibility has not been made
10or whose coverage has not become effective or an individual who has an appeal
11pending under sub. (3) c. 4. may access insulin under this subsection if the individual
12is in urgent need of insulin. To access a 30-day supply of insulin, the individual shall
13attest to the pharmacy that the individual is described in this paragraph and comply
14with par. (c) 1.
AB68-ASA2-AA2,95,19 15(3) Patient assistance program. (a) Establishment of program. No later than
16July 1, 2022, each manufacturer shall establish a patient assistance program to
17make insulin available in accordance with this subsection to individuals who meet
18the eligibility requirements under par. (b). Under the program, the manufacturer
19shall do all of the following:
AB68-ASA2-AA2,95,2220 1. Provide the commissioner with information regarding the program,
21including contact information for individuals to call for assistance in accessing the
22program.
AB68-ASA2-AA2,95,2423 2. Provide a hotline for individuals to call or access between 8 a.m. and 10 p.m.
24on weekdays and between 10 a.m. and 6 p.m. on Saturdays.
AB68-ASA2-AA2,96,2
13. List the eligibility requirements under par. (b) on the manufacturer's
2Internet site.
AB68-ASA2-AA2,96,63 4. Maintain the privacy of all information received from an individual applying
4for or participating in the program and not sell, share, or disseminate the
5information unless required under this section or authorized, in writing, by the
6individual.
AB68-ASA2-AA2,96,87 (b) Eligible individual. An individual shall be eligible to receive insulin under
8a patient assistance program if all of the following conditions are met:
AB68-ASA2-AA2,96,99 1. The individual is a resident of this state.
AB68-ASA2-AA2,96,1210 2. The individual, or the individual's parent or legal guardian if the individual
11is under the age of 18, has a valid Wisconsin driver's license or state identification
12card.
AB68-ASA2-AA2,96,1313 3. The individual has a valid insulin prescription.
AB68-ASA2-AA2,96,1614 4. The family income of the individual does not exceed 400 percent of the
15poverty line as defined and revised annually under 42 USC 9902 (2) for a family the
16size of the individual's family,
AB68-ASA2-AA2,96,1717 5. The individual is not receiving public assistance under ch. 49.
AB68-ASA2-AA2,96,2318 6. The individual is not eligible to receive health care through a federally
19funded program or receive prescription drug benefits through the U.S. department
20of veterans affairs, except that this subdivision does not apply to an individual who
21is enrolled in a policy under Part D of Medicare under 42 USC 1395w-101 et seq. if
22the individual has spent at least $1,000 on prescription drugs in the current calendar
23year.
AB68-ASA2-AA2,97,324 7. The individual is not enrolled in prescription drug coverage through an
25individual or group health plan that limits the total cost sharing amount, including

1copayments, deductibles, and coinsurance, that an enrollee is required to pay for a
230-day supply of insulin to no more than $75, regardless of the type or amount of
3insulin needed.
AB68-ASA2-AA2,97,124 (c) Application for patient assistance program. 1. An individual may apply to
5participate in a patient assistance program by filing an application with the
6manufacturer who established the program, the individual's health care practitioner
7if the practitioner participates in the program, or a navigator included on the list
8under sub. (8) (c). A health care practitioner or navigator shall immediately submit
9the application to the manufacturer. Upon receipt of an application, the
10manufacturer shall determine the individual's eligibility under par. (b) and, except
11as provided in subd. 2., notify the individual of the determination no later than 10
12days after receipt of the application.
AB68-ASA2-AA2,97,1813 2. If necessary to determine the individual's eligibility under par. (b), the
14manufacturer may request additional information from an individual who has filed
15an application under subd. 1. no later than 5 days after receipt of the application.
16Upon receipt of the additional information, the manufacturer shall determine the
17individual's eligibility under par. (b) and notify the individual of the determination
18no later than 3 days after receipt of the requested information.
AB68-ASA2-AA2,97,2419 3. Except as provided in subd. 5., if the manufacturer determines under subd.
201. or 2. that the individual is eligible for the patient assistance program, the
21manufacturer shall provide the individual with a statement of eligibility. The
22statement of eligibility shall be valid for 12 months and may be renewed upon a
23determination by the manufacturer that the individual continues to meet the
24eligibility requirements of par. (b).
AB68-ASA2-AA2,98,11
14. If the manufacturer determines under subd. 1. or 2. that the individual is not
2eligible for the patient assistance program, the manufacturer shall provide the
3reason for the determination in the notification under subd. 1. or 2. The individual
4may appeal the determination by filing an appeal with the commissioner that shall
5include all of the information provided to the manufacturer under subds. 1. and 2.
6The commissioner shall establish procedures for deciding appeals under this
7subdivision. The commissioner shall issue a decision no later than 10 days after the
8appeal is filed, and the commissioner's decision shall be final. If the commissioner
9determines that the individual meets the eligibility requirements under par. (b), the
10manufacturer shall provide the individual with the statement of eligibility described
11in subd. 3.
AB68-ASA2-AA2,98,2012 5. In the case of an individual who has prescription drug coverage through an
13individual or group health plan, if the manufacturer determines under subd. 1. or 2.
14that the individual is eligible for the patient assistance program but also determines
15that the individual's insulin needs are better addressed through the use of the
16manufacturer's copayment assistance program rather than the patient assistance
17program, the manufacturer shall inform the individual of the determination and
18provide the individual with the necessary coupons to submit to a pharmacy. The
19individual may not be required to pay more than the copayment amount specified in
20par. (d) 2.
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