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SB70-AA3,129 8Section 129. 601.31 (1) (nw) of the statutes is created to read:
SB70-AA3,110,119 601.31 (1) (nw) For issuing or renewing a license as a pharmacy services
10administrative organization under s. 632.864, an amount to be set by the
11commissioner by rule.
SB70-AA3,130 12Section 130. 601.575 of the statutes is created to read:
SB70-AA3,110,18 13601.575 Prescription drug importation program. (1) Importation
14program requirements.
The commissioner, in consultation with persons interested
15in the sale and pricing of prescription drugs and appropriate officials and agencies
16of the federal government, shall design and implement a prescription drug
17importation program for the benefit of residents of this state, that generates savings
18for residents, and that satisfies all of the following:
SB70-AA3,110,2119 (a) The commissioner shall designate a state agency to become a licensed
20wholesale distributor or to contract with a licensed wholesale distributor and shall
21seek federal certification and approval to import prescription drugs.
SB70-AA3,110,2322(b) The program shall comply with relevant requirements of 21 USC 384,
23including safety and cost savings requirements.
SB70-AA3,110,2524 (c) The program shall import prescription drugs from Canadian suppliers
25regulated under any appropriate Canadian or provincial laws.
SB70-AA3,111,2
1(d) The program shall have a process to sample the purity, chemical
2composition, and potency of imported prescription drugs.
SB70-AA3,111,63 (e) The program shall import only those prescription drugs for which
4importation creates substantial savings for residents of this state and only those
5prescription drugs that are not brand-name drugs and that have fewer than 4
6competitor prescription drugs in the United States.
SB70-AA3,111,87 (f) The commissioner shall ensure that prescription drugs imported under the
8program are not distributed, dispensed, or sold outside of this state.
SB70-AA3,111,99 (g) The program shall ensure all of the following:
SB70-AA3,111,1110 1. Participation by any pharmacy or health care provider in the program is
11voluntary.
SB70-AA3,111,1312 2. Any pharmacy or health care provider participating in the program has the
13appropriate license or other credential in this state.
SB70-AA3,111,1614 3. Any pharmacy or health care provider participating in the program charges
15a consumer or health plan the actual acquisition cost of the imported prescription
16drug that is dispensed.
SB70-AA3,111,2017 (h) The program shall ensure that a payment by a health plan or health
18insurance policy for a prescription drug imported under the program reimburses no
19more than the actual acquisition cost of the imported prescription drug that is
20dispensed.
SB70-AA3,111,2221 (i) The program shall ensure that any health plan or health insurance policy
22participating in the program does all of the following:
SB70-AA3,111,2423 1. Maintains a formulary and claims payment system with current information
24on prescription drugs imported under the program.
SB70-AA3,112,3
12. Bases cost-sharing amounts for participants or insureds under the plan or
2policy on no more than the actual acquisition cost of the prescription drug imported
3under the program that is dispensed to the participant or insured.
SB70-AA3,112,64 3. Demonstrates to the commissioner or a state agency designated by the
5commissioner how premiums under the plan or policy are affected by savings on
6prescription drugs imported under the program.
SB70-AA3,112,97 (j) Any wholesale distributor importing prescription drugs under the program
8shall limit its profit margin to the amount established by the commissioner or a state
9agency designated by the commissioner.
SB70-AA3,112,1110 (k) The program may not import any generic prescription drug that would
11violate federal patent laws on branded products in the United States.
SB70-AA3,112,1612(L) The program shall comply with tracking and tracing requirements of 21
13USC 360eee
and 360eee-1, to the extent practical and feasible, before the
14prescription drug to be imported comes into the possession of this state's wholesale
15distributor and fully after the prescription drug to be imported is in the possession
16of this state's wholesale distributor.
SB70-AA3,112,1817 (m) The program shall establish a fee or other mechanism to finance the
18program that does not jeopardize significant savings to residents of this state.
SB70-AA3,112,1919 (n) The program shall have an audit function that ensures all of the following:
SB70-AA3,112,2120 1. The commissioner has a sound methodology to determine the most
21cost-effective prescription drugs to include in the program.
SB70-AA3,112,2322 2. The commissioner has a process in place to select Canadian suppliers that
23are high quality, high performing, and in full compliance with Canadian laws.
SB70-AA3,112,2524 3. Prescription drugs imported under the program are pure, unadulterated,
25potent, and safe.
SB70-AA3,113,1
14. The program is complying with the requirements of this subsection.
SB70-AA3,113,32 5. The program is adequately financed to support administrative functions of
3the program while generating significant cost savings to residents of this state.
SB70-AA3,113,54 6. The program does not put residents of this state at a higher risk than if the
5program did not exist.
SB70-AA3,113,76 7. The program provides and is projected to continue to provide substantial cost
7savings to residents of this state.
SB70-AA3,113,10 8(2) Anticompetitive behavior. The commissioner, in consultation with the
9attorney general, shall identify the potential for and monitor anticompetitive
10behavior in industries affected by a prescription drug importation program.
SB70-AA3,113,20 11(3) Approval of program design; certification. No later than the first day of
12the 7th month beginning after the effective date of this subsection .... [LRB inserts
13date], the commissioner shall submit to the joint committee on finance a report that
14includes the design of the prescription drug importation program in accordance with
15this section. The commissioner may not submit the proposed program to the federal
16department of health and human services unless the joint committee on finance
17approves the proposed program. Within 14 days of the date of approval by the joint
18committee on finance of the proposed program, the commissioner shall submit to the
19federal department of health and human services a request for certification of the
20approved program.
SB70-AA3,114,3 21(4) Implementation of certified program. After the federal department of
22health and human services certifies the prescription drug importation program
23submitted under sub. (3), the commissioner shall begin implementation of the
24program, and the program shall be fully operational by 180 days after the date of
25certification by the federal department of health and human services. The

1commissioner shall do all of the following to implement the program to the extent the
2action is in accordance with other state laws and the certification by the federal
3department of health and human services:
SB70-AA3,114,64 (a) Become a licensed wholesale distributor, designate another state agency to
5become a licensed wholesale distributor, or contract with a licensed wholesale
6distributor.
SB70-AA3,114,87 (b) Contract with one or more Canadian suppliers that meet the criteria in sub.
8(1) (c) and (n).
SB70-AA3,114,119 (c) Create an outreach and marketing plan to communicate with and provide
10information to health plans and health insurance policies, employers, pharmacies,
11health care providers, and residents of this state on participating in the program.
SB70-AA3,114,1412 (d) Develop and implement a registration process for health plans and health
13insurance policies, pharmacies, and health care providers interested in participating
14in the program.
SB70-AA3,114,1615 (e) Create a publicly accessible source for listing prices of prescription drugs
16imported under the program.
SB70-AA3,114,1917 (f) Create, publicize, and implement a method of communication to promptly
18answer questions from and address the needs of persons affected by the
19implementation of the program before the program is fully operational.
SB70-AA3,114,2120 (g) Establish the audit functions under sub. (1) (n) with a timeline to complete
21each audit function every 2 years.
SB70-AA3,114,2322 (h) Conduct any other activities determined by the commissioner to be
23important to successful implementation of the program.
SB70-AA3,114,25 24(5) Report. By January 1 and July 1 of each year, the commissioner shall
25submit to the joint committee on finance a report including all of the following:
SB70-AA3,115,2
1(a) A list of prescription drugs included in the prescription drug importation
2program under this section.
SB70-AA3,115,53 (b) The number of pharmacies, health care providers, and health plans and
4health insurance policies participating in the prescription drug importation program
5under this section.
SB70-AA3,115,106 (c) The estimated amount of savings to residents of this state, health plans and
7health insurance policies, and employers resulting from the implementation of the
8prescription drug importation program under this section reported from the date of
9the previous report under this subsection and from the date the program was fully
10operational.
SB70-AA3,115,1211 (d) Findings of any audit functions under sub. (1) (n) completed since the date
12of the previous report under this subsection.
SB70-AA3,115,14 13(6) Rulemaking. The commissioner may promulgate any rules necessary to
14implement this section.
SB70-AA3,131 15Section 131. 601.59 of the statutes is created to read:
SB70-AA3,115,16 16601.59 State-based exchange. (1) Definitions. In this section:
SB70-AA3,115,1717 (a) “Exchange” has the meaning given in 45 CFR 155.20.
SB70-AA3,115,2018 (b) “State-based exchange on the federal platform” means an exchange that is
19described in and meets the requirements of 45 CFR 155.200 (f) and is approved by
20the federal secretary of health and human services under 45 CFR 155.106.
SB70-AA3,115,2421 (c) “State-based exchange without the federal platform” means an exchange,
22other than one described in 45 CFR 155.200 (f), that performs all the functions
23described in 45 CFR 155.200 (a) and is approved by the federal secretary of health
24and human services under 45 CFR 155.106.
SB70-AA3,116,7
1(2) Establishment and operation of state-based exchange. The commissioner
2shall establish and operate an exchange that at first is a state-based exchange on
3the federal platform and then subsequently transitions to a state-based exchange
4without the federal platform. The commissioner shall develop procedures to address
5the transition from the state-based exchange on the federal platform to the
6state-based exchange without the federal platform, including the circumstances
7that shall be met in order for the transition to occur.
SB70-AA3,116,10 8(3) Agreement with federal government. The commissioner may enter into
9any agreement with the federal government necessary to facilitate the
10implementation of this section.
SB70-AA3,116,16 11(4) User fees. The commissioner shall impose a user fee, as authorized under
1245 CFR 155.160 (b) (1), on each insurer that offers a health plan through the
13state-based exchange on the federal platform or the state-based exchange without
14the federal platform. The user fee shall be applied at one of the following rates on
15the total monthly premiums charged by an insurer for each policy under the plan for
16which enrollment is through the exchange:
SB70-AA3,116,1817 (a) For any plan year for which the commissioner operates a state-based
18exchange on the federal platform, the rate is 0.5 percent.
SB70-AA3,116,2219 (b) For the first 2 plan years for which the commissioner operates a state-based
20exchange without the federal platform, the rate is equal to the user fee rate the
21federal department of health and human services specifies under 45 CFR 156.50 (c)
22(1) for the federally facilitated exchanges for the applicable plan year.
SB70-AA3,116,2523 (c) Beginning with the 3rd plan year for which the commissioner operates a
24state-based exchange without the federal platform and for each plan year thereafter,
25the rate shall be set by the commissioner by rule.
SB70-AA3,117,2
1(5) Rules. The commissioner may promulgate rules necessary to implement
2this section.
SB70-AA3,132 3Section 132. 601.83 (1) (h) of the statutes is renumbered 601.83 (1) (h) (intro.)
4and amended to read:
SB70-AA3,117,105 601.83 (1) (h) (intro.) In 2019 and in each subsequent year Unless the joint
6committee on finance under s. 13.10 increases the amount upon request by the
7commissioner
, the commissioner may expend no more than $200,000,000 the
8following amounts
from all revenue sources for the healthcare stability plan under
9this section, unless the joint committee on finance under s. 13.10 has increased this
10amount upon request by the commissioner.
:
SB70-AA3,117,14 11(he) The commissioner shall ensure that sufficient funds are available for the
12healthcare stability plan under this section to operate as described in the approval
13of the federal department of health and human services dated July 29, 2018, and in
14any waiver extension approvals
.
SB70-AA3,133 15Section 133. 601.83 (1) (h) 1. and 3. of the statutes are created to read:
SB70-AA3,117,1616 601.83 (1) (h) 1. In 2019, 2020, and 2021, $200,000,000.
SB70-AA3,117,2517 3. In 2025 and in each year thereafter, the maximum expenditure amount for
18the previous year, adjusted to reflect the percentage increase, if any, in the consumer
19price index for all urban consumers, U.S. city average, for the medical care group, as
20determined by the U.S. department of labor, for the 12-month period ending on
21December 31 of the year before the year in which the amount is determined. The
22commissioner shall determine the annual adjustment amount for a particular year
23in January of the previous year. The commissioner shall publish the new maximum
24expenditure amount under this subdivision each year in the Wisconsin
25Administrative Register.
SB70-AA3,134
1Section 134. 601.83 (1) (hm) of the statutes is renumbered 601.83 (1) (h) 2. and
2amended to read:
SB70-AA3,118,53 601.83 (1) (h) 2. Notwithstanding par. (h), in In 2022 and in each year
4thereafter, the commissioner may expend from all revenue sources
, 2023, and 2024,
5$230,000,000 or less for the healthcare stability plan under this section.
SB70-AA3,135 6Section 135. 609.714 of the statutes is created to read:
SB70-AA3,118,9 7609.714 Substance abuse counselor coverage. Limited service health
8organizations, preferred provider plans, and defined network plans are subject to s.
9632.87 (8).
SB70-AA3,136 10Section 136. 609.719 of the statutes is created to read:
SB70-AA3,118,13 11609.719 Coverage for telehealth services. Limited service health
12organizations, preferred provider plans, and defined network plans are subject to s.
13632.871.
SB70-AA3,137 14Section 137. 609.83 of the statutes is amended to read:
SB70-AA3,118,18 15609.83 Coverage of drugs and devices ; application of payments.
16Limited service health organizations, preferred provider plans, and defined network
17plans are subject to ss. 632.853, 632.861, 632.862, and 632.895 (6) (b), (16t), and
18(16v).
SB70-AA3,138 19Section 138. 628.495 of the statutes is created to read:
SB70-AA3,118,22 20628.495 Pharmacy benefit management broker and consultant
21licenses.
(1) Definition. In this section, “pharmacy benefit manager” has the
22meaning given in s. 632.865 (1) (c).
SB70-AA3,119,2 23(2) License required. Beginning on the first day of the 12th month beginning
24after the effective date of this subsection .... [LRB inserts date], no individual may
25act as a pharmacy benefit management broker or consultant or any other individual

1who procures the services of a pharmacy benefit manager on behalf of a client
2without being licensed by the commissioner under this section.
SB70-AA3,119,5 3(3) Rules. The commissioner may promulgate rules to establish criteria and
4procedures for initial licensure and renewal of licensure and to implement licensure
5under this section.
SB70-AA3,139 6Section 139. 632.7495 (4) (b) of the statutes is amended to read:
SB70-AA3,119,77 632.7495 (4) (b) The coverage has a term of not more than 12 3 months.
SB70-AA3,140 8Section 140. 632.7495 (4) (c) of the statutes is amended to read:
SB70-AA3,119,139 632.7495 (4) (c) The coverage term aggregated with all consecutive periods of
10the insurer's coverage of the insured by individual health benefit plan coverage not
11required to be renewed under this subsection does not exceed 18 6 months. For
12purposes of this paragraph, coverage periods are consecutive if there are no more
13than 63 days between the coverage periods.
SB70-AA3,141 14Section 141. 632.7496 of the statutes is created to read:
SB70-AA3,119,17 15632.7496 Coverage requirements for short-term plans. (1) Definition.
16In this section, “short-term, limited duration plan” means an individual health
17benefit plan described in s. 632.7495 (4).
SB70-AA3,119,20 18(2) Guaranteed issue. An insurer that offers a short-term, limited duration
19plan shall accept every individual in this state who applies for coverage regardless
20of whether the individual has a preexisting condition.
SB70-AA3,120,2 21(3) Prohibiting discrimination based on health status. (a) An insurer that
22offers a short-term, limited duration plan may not establish rules for the eligibility
23of any individual to enroll, or for the continued eligibility of any individual to remain
24enrolled, under a short-term, limited duration plan based on any of the following

1health status-related factors with respect to the individual or a dependent of the
2individual:
SB70-AA3,120,33 1. Health status.
SB70-AA3,120,44 2. Medical condition, including both physical and mental illnesses.
SB70-AA3,120,55 3. Claims experience.
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