This is the preview version of the Wisconsin State Legislature site.
Please see http://docs.legis.wisconsin.gov for the production version.
AB68-SSA1,1372,53 3. The pharmacy may submit a reorder to the manufacturer if the individual's
4eligibility statement described in par. (c) 3. has not expired. The reorder shall be
5treated as an order for purposes of subd. 2.
AB68-SSA1,1372,86 4. Notwithstanding subds. 2. and 3., a manufacturer may send the insulin
7directly to the individual if the manufacturer provides a mail-order service option,
8in which case the pharmacy may not collect a copayment from the individual.
AB68-SSA1,1372,11 9(4) Exceptions. (a) This section does not apply to a manufacturer who shows
10to the commissioner's satisfaction that the manufacturer's annual gross revenue
11from insulin sales in this state does not exceed $2,000,000.
AB68-SSA1,1372,1612 (b) A manufacturer may not be required to make an insulin product available
13under sub. (2) or (3) if the wholesale acquisition cost of the insulin product does not
14exceed $8, as adjusted annually based on the U.S. consumer price index for all urban
15consumers, U.S. city average, per milliliter or the applicable national council for
16prescription drug programs' plan billing unit.
AB68-SSA1,1372,19 17(5) Confidentiality. All medical information solicited or obtained by any
18person under this section shall be subject to the applicable provisions of state law
19relating to confidentiality of medical information, including s. 610.70.
AB68-SSA1,1372,25 20(6) Reimbursement prohibition. No person, including a manufacturer,
21pharmacy, pharmacist, or 3rd-party administrator, as part of participating in an
22urgent need safety net program or patient assistance program may request or seek,
23or cause another person to request or seek, any reimbursement or other
24compensation for which payment may be made in whole or in part under a federal
25health care program, as defined in 42 USC 1320a-7b (f).
AB68-SSA1,1373,3
1(7) Reports. (a) Annually, no later than March 1, each manufacturer shall
2report to the commissioner all of the following information for the previous calendar
3year:
AB68-SSA1,1373,54 1. The number of individuals who received insulin under the manufacturer's
5urgent need safety net program.
AB68-SSA1,1373,86 2. The number of individuals who sought assistance under the manufacturer's
7patient assistance program and the number of individuals who were determined to
8be ineligible under sub. (3) (c) 4.
AB68-SSA1,1373,109 3. The wholesale acquisition cost of the insulin provided by the manufacturer
10through the urgent need safety net program and patient assistance program.
AB68-SSA1,1373,1411 (b) Annually, no later than April 1, the commissioner shall submit to the
12governor and the chief clerk of each house of the legislature, for distribution to the
13legislature under s. 13.172 (2), a report on the urgent need safety net programs and
14patient assistance programs that includes all of the following:
AB68-SSA1,1373,1515 1. The information provided to the commissioner under par. (a).
AB68-SSA1,1373,1716 2. The penalties assessed under sub. (9) during the previous calendar year,
17including the name of the manufacturer and amount of the penalty.
AB68-SSA1,1373,22 18(8) Additional responsibilities of commissioner. (a) Application form. The
19commissioner shall make the application form described in sub. (2) (c) 1. a. available
20on the office's Internet site and shall make the form available to pharmacies and
21health care providers who prescribe or dispense insulin, hospital emergency
22departments, urgent care clinics, and community health clinics.
AB68-SSA1,1373,2523 (b) Public outreach. 1. The commissioner shall conduct public outreach to
24create awareness of the urgent need safety net programs and patient assistance
25programs.
AB68-SSA1,1374,2
12. The commissioner shall develop and make available on the office's Internet
2site an information sheet that contains all of the following information:
AB68-SSA1,1374,43 a. A description of how to access insulin through an urgent need safety net
4program.
AB68-SSA1,1374,55 b. A description of how to access insulin through a patient assistance program.
AB68-SSA1,1374,76 c. Information on how to contact a navigator for assistance in accessing insulin
7through an urgent need safety net program or patient assistance program.
AB68-SSA1,1374,98 d. Information on how to contact the commissioner if a manufacturer
9determines that an individual is not eligible for a patient assistance program.
AB68-SSA1,1374,1110 e. A notification that an individual may contact the commissioner for more
11information or assistance in accessing ongoing affordable insulin options.
AB68-SSA1,1374,1812 (c) Navigators. The commissioner shall develop a training program to provide
13navigators with information and the resources necessary to assist individuals in
14accessing appropriate long-term insulin options. The commissioner shall compile
15a list of navigators who have completed the training program and are available to
16assist individuals in accessing affordable insulin coverage options. The list shall be
17made available on the office's Internet site and to pharmacies and health care
18practitioners who dispense and prescribe insulin.
AB68-SSA1,1374,2419 (d) Satisfaction surveys. 1. The commissioner shall develop and conduct a
20satisfaction survey of individuals who have accessed insulin through urgent need
21safety net programs and patient assistance programs. The survey shall ask whether
22the individual is still in need of a long-term solution for affordable insulin and shall
23include questions about the individual's satisfaction with all of the following, if
24applicable:
AB68-SSA1,1374,2525 a. Accessibility to urgent-need insulin.
AB68-SSA1,1375,2
1b. Adequacy of the information sheet and list of navigators received from the
2pharmacy.
AB68-SSA1,1375,33 c. Helpfulness of a navigator.
AB68-SSA1,1375,54 d. Ease of access in applying for a patient assistance program and receiving
5insulin from the pharmacy under the program.
AB68-SSA1,1375,96 2. The commissioner shall develop and conduct a satisfaction survey of
7pharmacies that have dispensed insulin through urgent need safety net programs
8and patient assistance programs. The survey shall include questions about the
9pharmacy's satisfaction with all of the following, if applicable:
AB68-SSA1,1375,1110 a. Timeliness of reimbursement from manufacturers for insulin dispensed by
11the pharmacy under urgent need safety net programs.
AB68-SSA1,1375,1212 b. Ease in submitting insulin orders to manufacturers.
AB68-SSA1,1375,1313 c. Timeliness of receiving insulin orders from manufacturers.
AB68-SSA1,1375,1514 3. The commissioner may contract with a nonprofit entity to develop and
15conduct the surveys under subds. 1. and 2. and to evaluate the survey results.
AB68-SSA1,1375,1816 4. No later than July 1, 2024, the commissioner shall submit to the governor
17and the chief clerk of each house of the legislature, for distribution to the legislature
18under s. 13.172 (2), a report on the results of the surveys under subds. 1. and 2.
AB68-SSA1,1375,23 19(9) Penalty. A manufacturer that fails to comply with this section may be
20assessed a penalty of up to $200,000 per month of noncompliance, with the maximum
21penalty increasing to $400,000 per month if the manufacturer continues to be in
22noncompliance after 6 months and increasing to $600,000 per month if the
23manufacturer continues to be in noncompliance after one year.
AB68-SSA1,3002 24Section 3002 . 632.869 of the statutes is created to read:
AB68-SSA1,1376,2
1632.869 Reimbursement to federal drug pricing program participants.
2 (1) In this section:
AB68-SSA1,1376,63 (a) “Covered entity” means an entity described in 42 USC 256b (a) (4) (A), (D),
4(E), (J), or (N) that participates in the federal drug pricing program under 42 USC
5256b
, a pharmacy of the entity, or a pharmacy contracted with the entity to dispense
6drugs purchased through the federal drug pricing program under 42 USC 256b.
AB68-SSA1,1376,77 (b) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
AB68-SSA1,1376,9 8(2) Any person, including a pharmacy benefit manager and 3rd-party payer,
9may not do any of the following:
AB68-SSA1,1376,1210 (a) Reimburse a covered entity for a drug that is subject to an agreement under
1142 USC 256b at a rate lower than that paid for the same drug to pharmacies that are
12not covered entities and are similar in prescription volume to the covered entity.
AB68-SSA1,1376,1513 (b) Assess a covered entity any fee, charge back, or other adjustment on the
14basis of the covered entity's participation in the federal drug pricing program under
1542 USC 256b.
AB68-SSA1,3003 16Section 3003 . 632.87 (4) of the statutes is amended to read:
AB68-SSA1,1376,2117 632.87 (4) No policy, plan or contract may exclude coverage for diagnosis and
18treatment of a condition or complaint by a licensed dentist or dental therapist within
19the scope of the dentist's or dental therapist's license, if the policy, plan or contract
20covers diagnosis and treatment of the condition or complaint by another health care
21provider, as defined in s. 146.81 (1) (a) to (p).
AB68-SSA1,3004 22Section 3004. 632.871 of the statutes is created to read:
AB68-SSA1,1376,23 23632.871 Telehealth services. (1) Definitions. In this section:
AB68-SSA1,1376,2424 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB68-SSA1,1376,2525 (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB68-SSA1,1377,6
1(c) “Telehealth" means a practice of health care delivery, diagnosis,
2consultation, treatment, or transfer of medically relevant data by means of audio,
3video, or data communications that are used either during a patient visit or a
4consultation or are used to transfer medically relevant data about a patient.
5“Telehealth" does not include communications delivered solely by audio-only
6telephone, facsimile machine, or e-mail unless specified otherwise by rule.
AB68-SSA1,1377,13 7(2) Coverage denial prohibited. No disability insurance policy or self-insured
8health plan may deny coverage for a treatment or service provided through
9telehealth on the basis that the treatment or service is provided through telehealth
10if that treatment or service is covered by the policy or plan when provided in person.
11A disability insurance policy or self-insured health plan may limit coverage of
12treatments or services provided through telehealth to those treatments or services
13that are medically necessary.
AB68-SSA1,1377,17 14(3) Certain limitations on telehealth prohibited. A disability insurance
15policy or self-insured health plan may not subject a treatment or service provided
16through telehealth for which coverage is required under sub. (2) to any of the
17following:
AB68-SSA1,1377,1918 (a) Any greater deductible, copayment, or coinsurance amount than would be
19applicable if the treatment or service is provided in person.
AB68-SSA1,1377,2220 (b) Any policy or calendar year or lifetime benefit limit or other maximum
21limitation that is not imposed on other treatments or services covered by the plan
22that are not provided through telehealth.
AB68-SSA1,1377,2423 (c) Prior authorization requirements that are not required for the same
24treatment or service when provided in person.
AB68-SSA1,1377,2525 (d) Unique location requirements.
AB68-SSA1,1378,5
1(4) Disclosure of coverage of certain telehealth services. A disability
2insurance policy or self-insured health plan that covers a telehealth treatment or
3service that has no equivalent in-person treatment or service, such as remote patient
4monitoring, shall specify in policy or plan materials the coverage of that telehealth
5treatment or service.
AB68-SSA1,3005 6Section 3005. 632.895 (6) (title) of the statutes is amended to read:
AB68-SSA1,1378,77 632.895 (6) (title) Equipment and supplies for treatment of diabetes; insulin.
AB68-SSA1,3006 8Section 3006 . 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and
9amended to read:
AB68-SSA1,1378,2010 632.895 (6) (a) Every disability insurance policy which that provides coverage
11of expenses incurred for treatment of diabetes shall provide coverage for expenses
12incurred by the installation and use of an insulin infusion pump, coverage for all
13other equipment and supplies, including insulin or any other prescription
14medication, used in the treatment of diabetes, and coverage of diabetic
15self-management education programs. Coverage Except as provided in par. (b),
16coverage
required under this subsection shall be subject to the same exclusions,
17limitations, deductibles, and coinsurance provisions of the policy as other covered
18expenses, except that insulin infusion pump coverage may be limited to the purchase
19of one pump per year and the insurer may require the insured to use a pump for 30
20days before purchase.
AB68-SSA1,3007 21Section 3007 . 632.895 (6) (b) of the statutes is created to read:
AB68-SSA1,1378,2222 632.895 (6) (b) 1. In this paragraph:
AB68-SSA1,1378,2423 a. “Cost sharing” means the total of any deductible, copayment, or coinsurance
24amounts imposed on a person covered under a policy or plan.
AB68-SSA1,1378,2525 b. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB68-SSA1,1379,3
12. Every disability insurance policy and self-insured health plan that covers
2insulin and imposes cost sharing on prescription drugs may not impose cost sharing
3on insulin in an amount that exceeds $50 for a one-month supply of insulin.
AB68-SSA1,1379,84 3. Nothing in this paragraph prohibits a disability insurance policy or
5self-insured health plan from imposing cost sharing on insulin in an amount less
6than the amount specified under subd. 2. Nothing in this paragraph requires a
7disability insurance policy or self-insured health plan to impose any cost sharing on
8insulin.
AB68-SSA1,3008 9Section 3008. 632.895 (8) (d) of the statutes is amended to read:
AB68-SSA1,1379,1610 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.
AB68-SSA1,3009 17Section 3009. 632.895 (13m) of the statutes is created to read:
AB68-SSA1,1379,1918 632.895 (13m) Preventive services. (a) In this section, “self-insured health
19plan” has the meaning given in s. 632.85 (1) (c).
AB68-SSA1,1379,2220 (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:
AB68-SSA1,1379,2323 1. Mammography in accordance with sub. (8).
AB68-SSA1,1379,2524 2. Genetic breast cancer screening and counseling and preventive medication
25for adult women at high risk for breast cancer.
AB68-SSA1,1380,2
13. Papanicolaou test for cancer screening for women 21 years of age or older
2with an intact cervix.
AB68-SSA1,1380,43 4. Human papillomavirus testing for women who have attained the age of 30
4years but have not attained the age of 66 years.
AB68-SSA1,1380,55 5. Colorectal cancer screening in accordance with sub. (16m).
AB68-SSA1,1380,86 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.
AB68-SSA1,1380,109 7. Skin cancer screening for individuals who have attained the age of 10 years
10but have not attained the age of 22 years.
AB68-SSA1,1380,1211 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.
AB68-SSA1,1380,1413 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.
AB68-SSA1,1380,1715 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.
AB68-SSA1,1380,1918 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.
AB68-SSA1,1380,2220 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.
AB68-SSA1,1380,2423 13. Behavioral counseling for cardiovascular health for adults who are
24overweight or obese and who have risk factors for cardiovascular disease.
AB68-SSA1,1380,2525 14. Type II diabetes screening for adults with elevated blood pressure.
AB68-SSA1,1381,2
115. Depression screening for minors 11 years of age or older and for adults when
2follow-up supports are available.
AB68-SSA1,1381,43 16. Hepatitis B screening for minors at high risk for infection and adults at high
4risk for infection.
AB68-SSA1,1381,65 17. Hepatitis C screening for adults at high risk for infection and onetime
6hepatitis C screening for adults born in any year from 1945 to 1965.
AB68-SSA1,1381,107 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.
AB68-SSA1,1381,1211 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.
Loading...
Loading...