Amendment AA3-SB70

SB70-AA3,111,9 (g) The program shall ensure all of the following:

SB70-AA3,111,11 1. Participation by any pharmacy or health care provider in the program is voluntary.

SB70-AA3,111,13 2. Any pharmacy or health care provider participating in the program has the appropriate license or other credential in this state.

SB70-AA3,111,16 3. Any pharmacy or health care provider participating in the program charges a consumer or health plan the actual acquisition cost of the imported prescription drug that is dispensed.

SB70-AA3,111,20 (h) The program shall ensure that a payment by a health plan or health insurance policy for a prescription drug imported under the program reimburses no more than the actual acquisition cost of the imported prescription drug that is dispensed.

SB70-AA3,111,22 (i) The program shall ensure that any health plan or health insurance policy participating in the program does all of the following:

SB70-AA3,111,24 1. Maintains a formulary and claims payment system with current information on prescription drugs imported under the program.

SB70-AA3,112,3 2. Bases cost-sharing amounts for participants or insureds under the plan or policy on no more than the actual acquisition cost of the prescription drug imported under the program that is dispensed to the participant or insured.

SB70-AA3,112,6 3. Demonstrates to the commissioner or a state agency designated by the commissioner how premiums under the plan or policy are affected by savings on prescription drugs imported under the program.

SB70-AA3,112,9 (j) Any wholesale distributor importing prescription drugs under the program shall limit its profit margin to the amount established by the commissioner or a state agency designated by the commissioner.

SB70-AA3,112,11 (k) The program may not import any generic prescription drug that would violate federal patent laws on branded products in the United States.

SB70-AA3,112,16 (L) The program shall comply with tracking and tracing requirements of 21 USC 360eee and 360eee-1, to the extent practical and feasible, before the prescription drug to be imported comes into the possession of this state's wholesale distributor and fully after the prescription drug to be imported is in the possession of this state's wholesale distributor.

SB70-AA3,112,18 (m) The program shall establish a fee or other mechanism to finance the program that does not jeopardize significant savings to residents of this state.

SB70-AA3,112,19 (n) The program shall have an audit function that ensures all of the following:

SB70-AA3,112,21 1. The commissioner has a sound methodology to determine the most cost-effective prescription drugs to include in the program.

SB70-AA3,112,23 2. The commissioner has a process in place to select Canadian suppliers that are high quality, high performing, and in full compliance with Canadian laws.

SB70-AA3,112,25 3. Prescription drugs imported under the program are pure, unadulterated, potent, and safe.

SB70-AA3,113,1 4. The program is complying with the requirements of this subsection.

SB70-AA3,113,3 5. The program is adequately financed to support administrative functions of the program while generating significant cost savings to residents of this state.

SB70-AA3,113,5 6. The program does not put residents of this state at a higher risk than if the program did not exist.

SB70-AA3,113,7 7. The program provides and is projected to continue to provide substantial cost savings to residents of this state.

SB70-AA3,113,10 (2) Anticompetitive behavior. The commissioner, in consultation with the attorney general, shall identify the potential for and monitor anticompetitive behavior in industries affected by a prescription drug importation program.

SB70-AA3,113,20 (3) Approval of program design; certification. No later than the first day of the 7th month beginning after the effective date of this subsection .... [LRB inserts date], the commissioner shall submit to the joint committee on finance a report that includes the design of the prescription drug importation program in accordance with this section. The commissioner may not submit the proposed program to the federal department of health and human services unless the joint committee on finance approves the proposed program. Within 14 days of the date of approval by the joint committee on finance of the proposed program, the commissioner shall submit to the federal department of health and human services a request for certification of the approved program.

SB70-AA3,114,3 (4) Implementation of certified program. After the federal department of health and human services certifies the prescription drug importation program submitted under sub. (3), the commissioner shall begin implementation of the program, and the program shall be fully operational by 180 days after the date of certification by the federal department of health and human services. The commissioner shall do all of the following to implement the program to the extent the action is in accordance with other state laws and the certification by the federal department of health and human services:

SB70-AA3,114,6 (a) Become a licensed wholesale distributor, designate another state agency to become a licensed wholesale distributor, or contract with a licensed wholesale distributor.

SB70-AA3,114,8 (b) Contract with one or more Canadian suppliers that meet the criteria in sub. (1) (c) and (n).

SB70-AA3,114,11 (c) Create an outreach and marketing plan to communicate with and provide information to health plans and health insurance policies, employers, pharmacies, health care providers, and residents of this state on participating in the program.

SB70-AA3,114,14 (d) Develop and implement a registration process for health plans and health insurance policies, pharmacies, and health care providers interested in participating in the program.

SB70-AA3,114,16 (e) Create a publicly accessible source for listing prices of prescription drugs imported under the program.

SB70-AA3,114,19 (f) Create, publicize, and implement a method of communication to promptly answer questions from and address the needs of persons affected by the implementation of the program before the program is fully operational.

SB70-AA3,114,21 (g) Establish the audit functions under sub. (1) (n) with a timeline to complete each audit function every 2 years.

SB70-AA3,114,23 (h) Conduct any other activities determined by the commissioner to be important to successful implementation of the program.

SB70-AA3,114,25 (5) Report. By January 1 and July 1 of each year, the commissioner shall submit to the joint committee on finance a report including all of the following:

SB70-AA3,115,2 (a) A list of prescription drugs included in the prescription drug importation program under this section.

SB70-AA3,115,5 (b) The number of pharmacies, health care providers, and health plans and health insurance policies participating in the prescription drug importation program under this section.

SB70-AA3,115,10 (c) The estimated amount of savings to residents of this state, health plans and health insurance policies, and employers resulting from the implementation of the prescription drug importation program under this section reported from the date of the previous report under this subsection and from the date the program was fully operational.

SB70-AA3,115,12 (d) Findings of any audit functions under sub. (1) (n) completed since the date of the previous report under this subsection.

SB70-AA3,115,14 (6) Rulemaking. The commissioner may promulgate any rules necessary to implement this section.

SB70-AA3,131 Section 131. 601.59 of the statutes is created to read:

SB70-AA3,115,16 601.59 State-based exchange. (1) Definitions. In this section:

SB70-AA3,115,17 (a) “Exchange” has the meaning given in 45 CFR 155.20.

SB70-AA3,115,20 (b) “State-based exchange on the federal platform” means an exchange that is described in and meets the requirements of 45 CFR 155.200 (f) and is approved by the federal secretary of health and human services under 45 CFR 155.106.

SB70-AA3,115,24 (c) “State-based exchange without the federal platform” means an exchange, other than one described in 45 CFR 155.200 (f), that performs all the functions described in 45 CFR 155.200 (a) and is approved by the federal secretary of health and human services under 45 CFR 155.106.

SB70-AA3,116,7 (2) Establishment and operation of state-based exchange. The commissioner shall establish and operate an exchange that at first is a state-based exchange on the federal platform and then subsequently transitions to a state-based exchange without the federal platform. The commissioner shall develop procedures to address the transition from the state-based exchange on the federal platform to the state-based exchange without the federal platform, including the circumstances that shall be met in order for the transition to occur.

SB70-AA3,116,10 (3) Agreement with federal government. The commissioner may enter into any agreement with the federal government necessary to facilitate the implementation of this section.

SB70-AA3,116,16 (4) User fees. The commissioner shall impose a user fee, as authorized under 45 CFR 155.160 (b) (1), on each insurer that offers a health plan through the state-based exchange on the federal platform or the state-based exchange without the federal platform. The user fee shall be applied at one of the following rates on the total monthly premiums charged by an insurer for each policy under the plan for which enrollment is through the exchange:

SB70-AA3,116,18 (a) For any plan year for which the commissioner operates a state-based exchange on the federal platform, the rate is 0.5 percent.

SB70-AA3,116,22 (b) For the first 2 plan years for which the commissioner operates a state-based exchange without the federal platform, the rate is equal to the user fee rate the federal department of health and human services specifies under 45 CFR 156.50 (c) (1) for the federally facilitated exchanges for the applicable plan year.

SB70-AA3,116,25 (c) Beginning with the 3rd plan year for which the commissioner operates a state-based exchange without the federal platform and for each plan year thereafter, the rate shall be set by the commissioner by rule.

SB70-AA3,117,2 (5) Rules. The commissioner may promulgate rules necessary to implement this section.

SB70-AA3,132 Section 132. 601.83 (1) (h) of the statutes is renumbered 601.83 (1) (h) (intro.) and amended to read:

SB70-AA3,117,10 601.83 (1) (h) (intro.) In 2019 and in each subsequent year Unless the joint committee on finance under s. 13.10 increases the amount upon request by the commissioner, the commissioner may expend no more than $200,000,000 the following amounts from all revenue sources for the healthcare stability plan under this section, unless the joint committee on finance under s. 13.10 has increased this amount upon request by the commissioner.:

SB70-AA3,117,14 (he) The commissioner shall ensure that sufficient funds are available for the healthcare stability plan under this section to operate as described in the approval of the federal department of health and human services dated July 29, 2018, and in any waiver extension approvals.

SB70-AA3,133 Section 133. 601.83 (1) (h) 1. and 3. of the statutes are created to read:

SB70-AA3,117,16 601.83 (1) (h) 1. In 2019, 2020, and 2021, $200,000,000.

SB70-AA3,117,25 3. In 2025 and in each year thereafter, the maximum expenditure amount for the previous year, adjusted to reflect the percentage increase, if any, in the consumer price index for all urban consumers, U.S. city average, for the medical care group, as determined by the U.S. department of labor, for the 12-month period ending on December 31 of the year before the year in which the amount is determined. The commissioner shall determine the annual adjustment amount for a particular year in January of the previous year. The commissioner shall publish the new maximum expenditure amount under this subdivision each year in the Wisconsin Administrative Register.

SB70-AA3,134 Section 134. 601.83 (1) (hm) of the statutes is renumbered 601.83 (1) (h) 2. and amended to read:

SB70-AA3,118,5 601.83 (1) (h) 2. Notwithstanding par. (h), in In 2022 and in each year thereafter, the commissioner may expend from all revenue sources , 2023, and 2024, $230,000,000 or less for the healthcare stability plan under this section.

SB70-AA3,135 Section 135. 609.714 of the statutes is created to read:

SB70-AA3,118,9 609.714 Substance abuse counselor coverage. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.87 (8).

SB70-AA3,136 Section 136. 609.719 of the statutes is created to read:

SB70-AA3,118,13 609.719 Coverage for telehealth services. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.871.

SB70-AA3,137 Section 137. 609.83 of the statutes is amended to read:

SB70-AA3,118,18 609.83 Coverage of drugs and devices ; application of payments. Limited service health organizations, preferred provider plans, and defined network plans are subject to ss. 632.853, 632.861, 632.862, and 632.895 (6) (b), (16t), and (16v).

SB70-AA3,138 Section 138. 628.495 of the statutes is created to read:

SB70-AA3,118,22 628.495 Pharmacy benefit management broker and consultant licenses. (1) Definition. In this section, “pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

SB70-AA3,119,2 (2) License required. Beginning on the first day of the 12th month beginning after the effective date of this subsection .... [LRB inserts date], no individual may act as a pharmacy benefit management broker or consultant or any other individual who procures the services of a pharmacy benefit manager on behalf of a client without being licensed by the commissioner under this section.

SB70-AA3,119,5 (3) Rules. The commissioner may promulgate rules to establish criteria and procedures for initial licensure and renewal of licensure and to implement licensure under this section.

SB70-AA3,139 Section 139. 632.7495 (4) (b) of the statutes is amended to read:

SB70-AA3,119,7 632.7495 (4) (b) The coverage has a term of not more than 12 3 months.

SB70-AA3,140 Section 140. 632.7495 (4) (c) of the statutes is amended to read:

SB70-AA3,119,13 632.7495 (4) (c) The coverage term aggregated with all consecutive periods of the insurer's coverage of the insured by individual health benefit plan coverage not required to be renewed under this subsection does not exceed 18 6 months. For purposes of this paragraph, coverage periods are consecutive if there are no more than 63 days between the coverage periods.

SB70-AA3,141 Section 141. 632.7496 of the statutes is created to read:

SB70-AA3,119,17 632.7496 Coverage requirements for short-term plans. (1) Definition. In this section, “short-term, limited duration plan” means an individual health benefit plan described in s. 632.7495 (4).

SB70-AA3,119,20 (2) Guaranteed issue. An insurer that offers a short-term, limited duration plan shall accept every individual in this state who applies for coverage regardless of whether the individual has a preexisting condition.

SB70-AA3,120,2 (3) Prohibiting discrimination based on health status. (a) An insurer that offers a short-term, limited duration plan may not establish rules for the eligibility of any individual to enroll, or for the continued eligibility of any individual to remain enrolled, under a short-term, limited duration plan based on any of the following health status-related factors with respect to the individual or a dependent of the individual:

SB70-AA3,120,3 1. Health status.

SB70-AA3,120,4 2. Medical condition, including both physical and mental illnesses.

SB70-AA3,120,5 3. Claims experience.

SB70-AA3,120,6 4. Receipt of health care.

SB70-AA3,120,7 5. Medical history.

SB70-AA3,120,8 6. Genetic information.

SB70-AA3,120,10 7. Evidence of insurability, including conditions arising out of acts of domestic violence.

SB70-AA3,120,11 8. Disability.

SB70-AA3,120,19 (b) An insurer that offers a short-term, limited duration plan may not require any individual, as a condition of enrollment or continued enrollment under the short-term, limited duration plan, to pay, on the basis of any health status-related factor described under par. (a) with respect to the individual or a dependent of the individual, a premium or contribution or a deductible, copayment, or coinsurance amount that is greater than the premium or contribution or deductible, copayment, or coinsurance amount respectively for a similarly situated individual enrolled under the short-term, limited duration plan.

SB70-AA3,120,22 (4) Premium rate variation. An insurer that offers a short-term, limited duration plan may vary premium rates for a specific short-term, limited duration plan based only on the following considerations:

SB70-AA3,120,24 (a) Whether the short-term, limited duration plan covers an individual or a family.

SB70-AA3,120,25 (b) Rating area in the state, as established by the commissioner.

SB70-AA3,121,3 (c) Age, except that the rate may not vary by more than 3 to 1 for adults over the age groups and the age bands shall be consistent with recommendations of the National Association of Insurance Commissioners.