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AB557,7,2318 3. Except as provided in subd. 5., if the manufacturer determines under subd.
191. or 2. that the individual is eligible for the patient assistance program, the
20manufacturer shall provide the individual with a statement of eligibility. The
21statement of eligibility shall be valid for 12 months and may be renewed upon a
22determination by the manufacturer that the individual continues to meet the
23eligibility requirements of par. (b).
AB557,8,924 4. If the manufacturer determines under subd. 1. or 2. that the individual is not
25eligible for the patient assistance program, the manufacturer shall provide the

1reason for the determination in the notification under subd. 1. or 2. The individual
2may appeal the determination by filing an appeal with the commissioner that shall
3include all of the information provided to the manufacturer under subds. 1. and 2.
4The commissioner shall establish procedures for deciding appeals under this
5subdivision. The commissioner shall issue a decision no later than 10 days after the
6appeal is filed, and the commissioner's decision shall be final. If the commissioner
7determines that the individual meets the eligibility requirements under par. (b), the
8manufacturer shall provide the individual with the statement of eligibility described
9in subd. 3.
AB557,8,1810 5. In the case of an individual who has prescription drug coverage through an
11individual or group health plan, if the manufacturer determines under subd. 1. or 2.
12that the individual is eligible for the patient assistance program but also determines
13that the individual's insulin needs are better addressed through the use of the
14manufacturer's copayment assistance program rather than the patient assistance
15program, the manufacturer shall inform the individual of the determination and
16provide the individual with the necessary coupons to submit to a pharmacy. The
17individual may not be required to pay more than the copayment amount specified in
18par. (d) 2.
AB557,8,2519 (d) Provision of insulin under a patient assistance program. 1. Upon receipt
20from an individual of the eligibility statement described in par. (c) 3. and a valid
21insulin prescription, a pharmacy shall submit an order containing the name of the
22insulin and daily dosage amount to the manufacturer. The pharmacy shall include
23with the order the pharmacy's name, shipping address, office telephone number, fax
24number, electronic mail address, and contact name, as well as any days or times
25when deliveries are not accepted by the pharmacy.
AB557,9,9
12. Upon receipt of an order meeting the requirements under subd. 1., the
2manufacturer shall send the pharmacy a 90-day supply of insulin, or lesser amount
3if requested in the order, at no charge to the individual or pharmacy. The pharmacy
4shall dispense the insulin to the individual associated with the order. The insulin
5shall be dispensed at no charge to the individual, except that the pharmacy may
6collect a copayment from the individual to cover the pharmacy's costs for processing
7and dispensing in an amount not to exceed $50 for each 90-day supply of insulin.
8The pharmacy may not seek reimbursement from the manufacturer or a 3rd-party
9payer.
AB557,9,1210 3. The pharmacy may submit a reorder to the manufacturer if the individual's
11eligibility statement described in par. (c) 3. has not expired. The reorder shall be
12treated as an order for purposes of subd. 2.
AB557,9,1513 4. Notwithstanding subds. 2. and 3., a manufacturer may send the insulin
14directly to the individual if the manufacturer provides a mail-order service option,
15in which case the pharmacy may not collect a copayment from the individual.
AB557,9,18 16(4) Exceptions. (a) This section does not apply to a manufacturer who shows
17to the commissioner's satisfaction that the manufacturer's annual gross revenue
18from insulin sales in this state does not exceed $2,000,000.
AB557,9,2319 (b) A manufacturer may not be required to make an insulin product available
20under sub. (2) or (3) if the wholesale acquisition cost of the insulin product does not
21exceed $8, as adjusted annually based on the U.S. consumer price index for all urban
22consumers, U.S. city average, per milliliter or the applicable national council for
23prescription drug programs' plan billing unit.
AB557,10,3
1(5) Confidentiality. All medical information solicited or obtained by any
2person under this section shall be subject to the applicable provisions of state law
3relating to confidentiality of medical information, including s. 610.70.
AB557,10,9 4(6) Reimbursement prohibition. No person, including a manufacturer,
5pharmacy, pharmacist, or 3rd-party administrator, as part of participating in an
6urgent need safety net program or patient assistance program may request or seek,
7or cause another person to request or seek, any reimbursement or other
8compensation for which payment may be made in whole or in part under a federal
9health care program, as defined in 42 USC 1320a-7b (f).
AB557,10,12 10(7) Reports. (a) Annually, no later than March 1, each manufacturer shall
11report to the commissioner all of the following information for the previous calendar
12year:
AB557,10,1413 1. The number of individuals who received insulin under the manufacturer's
14urgent need safety net program.
AB557,10,1715 2. The number of individuals who sought assistance under the manufacturer's
16patient assistance program and the number of individuals who were determined to
17be ineligible under sub. (3) (c) 4.
AB557,10,1918 3. The wholesale acquisition cost of the insulin provided by the manufacturer
19through the urgent need safety net program and patient assistance program.
AB557,10,2320 (b) Annually, no later than April 1, the commissioner shall submit to the
21governor and the chief clerk of each house of the legislature, for distribution to the
22legislature under s. 13.172 (2), a report on the urgent need safety net programs and
23patient assistance programs that includes all of the following:
AB557,10,2424 1. The information provided to the commissioner under par. (a).
AB557,11,2
12. The penalties assessed under sub. (9) during the previous calendar year,
2including the name of the manufacturer and amount of the penalty.
AB557,11,7 3(8) Additional responsibilities of commissioner. (a) Application form. The
4commissioner shall make the application form described in sub. (2) (c) 1. a. available
5on the office's Internet site and shall make the form available to pharmacies and
6health care providers who prescribe or dispense insulin, hospital emergency
7departments, urgent care clinics, and community health clinics.
AB557,11,108 (b) Public outreach. 1. The commissioner shall conduct public outreach to
9create awareness of the urgent need safety net programs and patient assistance
10programs.
AB557,11,1211 2. The commissioner shall develop and make available on the office's Internet
12site an information sheet that contains all of the following information:
AB557,11,1413 a. A description of how to access insulin through an urgent need safety net
14program.
AB557,11,1515 b. A description of how to access insulin through a patient assistance program.
AB557,11,1716 c. Information on how to contact a navigator for assistance in accessing insulin
17through an urgent need safety net program or patient assistance program.
AB557,11,1918 d. Information on how to contact the commissioner if a manufacturer
19determines that an individual is not eligible for a patient assistance program.
AB557,11,2120 e. A notification that an individual may contact the commissioner for more
21information or assistance in accessing ongoing affordable insulin options.
AB557,12,322 (c) Navigators. The commissioner shall develop a training program to provide
23navigators with information and the resources necessary to assist individuals in
24accessing appropriate long-term insulin options. The commissioner shall compile
25a list of navigators who have completed the training program and are available to

1assist individuals in accessing affordable insulin coverage options. The list shall be
2made available on the office's Internet site and to pharmacies and health care
3practitioners who dispense and prescribe insulin.
AB557,12,94 (d) Satisfaction surveys. 1. The commissioner shall develop and conduct a
5satisfaction survey of individuals who have accessed insulin through urgent need
6safety net programs and patient assistance programs. The survey shall ask whether
7the individual is still in need of a long-term solution for affordable insulin and shall
8include questions about the individual's satisfaction with all of the following, if
9applicable:
AB557,12,1010 a. Accessibility to urgent-need insulin.
AB557,12,1211 b. Adequacy of the information sheet and list of navigators received from the
12pharmacy.
AB557,12,1313 c. Helpfulness of a navigator.
AB557,12,1514 d. Ease of access in applying for a patient assistance program and receiving
15insulin from the pharmacy under the program.
AB557,12,1916 2. The commissioner shall develop and conduct a satisfaction survey of
17pharmacies that have dispensed insulin through urgent need safety net programs
18and patient assistance programs. The survey shall include questions about the
19pharmacy's satisfaction with all of the following, if applicable:
AB557,12,2120 a. Timeliness of reimbursement from manufacturers for insulin dispensed by
21the pharmacy under urgent need safety net programs.
AB557,12,2222 b. Ease in submitting insulin orders to manufacturers.
AB557,12,2323 c. Timeliness of receiving insulin orders from manufacturers.
AB557,12,2524 3. The commissioner may contract with a nonprofit entity to develop and
25conduct the surveys under subds. 1. and 2. and to evaluate the survey results.
AB557,13,3
14. No later than July 1, 2024, the commissioner shall submit to the governor
2and the chief clerk of each house of the legislature, for distribution to the legislature
3under s. 13.172 (2), a report on the results of the surveys under subds. 1. and 2.
AB557,13,8 4(9) Penalty. A manufacturer that fails to comply with this section may be
5assessed a penalty of up to $200,000 per month of noncompliance, with the maximum
6penalty increasing to $400,000 per month if the manufacturer continues to be in
7noncompliance after 6 months and increasing to $600,000 per month if the
8manufacturer continues to be in noncompliance after one year.
AB557,13,99 (End)
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