Amendment SA4-SSA2-SB70

SB70-SSA2-SA4,104,3 5. In the case of an individual who has prescription drug coverage through an individual or group health plan, if the manufacturer determines under subd. 1. or 2. that the individual is eligible for the patient assistance program but also determines that the individual's insulin needs are better addressed through the use of the manufacturer's copayment assistance program rather than the patient assistance program, the manufacturer shall inform the individual of the determination and provide the individual with the necessary coupons to submit to a pharmacy. The individual may not be required to pay more than the copayment amount specified in par. (d) 2.

SB70-SSA2-SA4,104,10 (d) Provision of insulin under a patient assistance program. 1. Upon receipt from an individual of the eligibility statement described in par. (c) 3. and a valid insulin prescription, a pharmacy shall submit an order containing the name of the insulin and daily dosage amount to the manufacturer. The pharmacy shall include with the order the pharmacy's name, shipping address, office telephone number, fax number, email address, and contact name, as well as any days or times when deliveries are not accepted by the pharmacy.

SB70-SSA2-SA4,104,19 2. Upon receipt of an order meeting the requirements under subd. 1., the manufacturer shall send the pharmacy a 90-day supply of insulin, or lesser amount if requested in the order, at no charge to the individual or pharmacy. The pharmacy shall dispense the insulin to the individual associated with the order. The insulin shall be dispensed at no charge to the individual, except that the pharmacy may collect a copayment from the individual to cover the pharmacy's costs for processing and dispensing in an amount not to exceed $50 for each 90-day supply of insulin. The pharmacy may not seek reimbursement from the manufacturer or a 3rd-party payer.

SB70-SSA2-SA4,104,22 3. The pharmacy may submit a reorder to the manufacturer if the individual's eligibility statement described in par. (c) 3. has not expired. The reorder shall be treated as an order for purposes of subd. 2.

SB70-SSA2-SA4,104,25 4. Notwithstanding subds. 2. and 3., a manufacturer may send the insulin directly to the individual if the manufacturer provides a mail-order service option, in which case the pharmacy may not collect a copayment from the individual.

SB70-SSA2-SA4,105,3 (4) Exceptions. (a) This section does not apply to a manufacturer that shows to the commissioner's satisfaction that the manufacturer's annual gross revenue from insulin sales in this state does not exceed $2,000,000.

SB70-SSA2-SA4,105,8 (b) A manufacturer may not be required to make an insulin product available under sub. (2) or (3) if the wholesale acquisition cost of the insulin product does not exceed $8, as adjusted annually based on the U.S. consumer price index for all urban consumers, U.S. city average, per milliliter or the applicable national council for prescription drug programs' plan billing unit.

SB70-SSA2-SA4,105,11 (5) Confidentiality. All medical information solicited or obtained by any person under this section shall be subject to the applicable provisions of state law relating to confidentiality of medical information, including s. 610.70.

SB70-SSA2-SA4,105,17 (6) Reimbursement prohibition. No person, including a manufacturer, pharmacy, pharmacist, or 3rd-party administrator, as part of participating in an urgent need safety net program or patient assistance program may request or seek, or cause another person to request or seek, any reimbursement or other compensation for which payment may be made in whole or in part under a federal health care program, as defined in 42 USC 1320a-7b (f).

SB70-SSA2-SA4,105,20 (7) Reports. (a) Annually, no later than March 1, each manufacturer shall report to the commissioner all of the following information for the previous calendar year:

SB70-SSA2-SA4,105,22 1. The number of individuals who received insulin under the manufacturer's urgent need safety net program.

SB70-SSA2-SA4,105,25 2. The number of individuals who sought assistance under the manufacturer's patient assistance program and the number of individuals who were determined to be ineligible under sub. (3) (c) 4.

SB70-SSA2-SA4,106,2 3. The wholesale acquisition cost of the insulin provided by the manufacturer through the urgent need safety net program and patient assistance program.

SB70-SSA2-SA4,106,6 (b) Annually, no later than April 1, the commissioner shall submit to the governor and the chief clerk of each house of the legislature, for distribution to the legislature under s. 13.172 (2), a report on the urgent need safety net programs and patient assistance programs that includes all of the following:

SB70-SSA2-SA4,106,7 1. The information provided to the commissioner under par. (a).

SB70-SSA2-SA4,106,9 2. The penalties assessed under sub. (9) during the previous calendar year, including the name of the manufacturer and amount of the penalty.

SB70-SSA2-SA4,106,14 (8) Additional responsibilities of commissioner. (a) Application form. The commissioner shall make the application form described in sub. (2) (c) 1. a. available on the office's website and shall make the form available to pharmacies and health care providers who prescribe or dispense insulin, hospital emergency departments, urgent care clinics, and community health clinics.

SB70-SSA2-SA4,106,17 (b) Public outreach. 1. The commissioner shall conduct public outreach to create awareness of the urgent need safety net programs and patient assistance programs.

SB70-SSA2-SA4,106,19 2. The commissioner shall develop and make available on the office's website an information sheet that contains all of the following information:

SB70-SSA2-SA4,106,21 a. A description of how to access insulin through an urgent need safety net program.

SB70-SSA2-SA4,106,22 b. A description of how to access insulin through a patient assistance program.

SB70-SSA2-SA4,106,24 c. Information on how to contact a navigator for assistance in accessing insulin through an urgent need safety net program or patient assistance program.

SB70-SSA2-SA4,107,2 d. Information on how to contact the commissioner if a manufacturer determines that an individual is not eligible for a patient assistance program.

SB70-SSA2-SA4,107,4 e. A notification that an individual may contact the commissioner for more information or assistance in accessing ongoing affordable insulin options.

SB70-SSA2-SA4,107,11 (c) Navigators. The commissioner shall develop a training program to provide navigators with information and the resources necessary to assist individuals in accessing appropriate long-term insulin options. The commissioner shall compile a list of navigators that have completed the training program and are available to assist individuals in accessing affordable insulin coverage options. The list shall be made available on the office's website and to pharmacies and health care practitioners who dispense and prescribe insulin.

SB70-SSA2-SA4,107,17 (d) Satisfaction surveys. 1. The commissioner shall develop and conduct a satisfaction survey of individuals who have accessed insulin through urgent need safety net programs and patient assistance programs. The survey shall ask whether the individual is still in need of a long-term solution for affordable insulin and shall include questions about the individual's satisfaction with all of the following, if applicable:

SB70-SSA2-SA4,107,18 a. Accessibility to urgent-need insulin.

SB70-SSA2-SA4,107,20 b. Adequacy of the information sheet and list of navigators received from the pharmacy.

SB70-SSA2-SA4,107,21 c. Helpfulness of a navigator.

SB70-SSA2-SA4,107,23 d. Ease of access in applying for a patient assistance program and receiving insulin from the pharmacy under the patient assistance program.

SB70-SSA2-SA4,108,2 2. The commissioner shall develop and conduct a satisfaction survey of pharmacies that have dispensed insulin through urgent need safety net programs and patient assistance programs. The survey shall include questions about the pharmacy's satisfaction with all of the following, if applicable:

SB70-SSA2-SA4,108,4 a. Timeliness of reimbursement from manufacturers for insulin dispensed by the pharmacy under urgent need safety net programs.

SB70-SSA2-SA4,108,5 b. Ease in submitting insulin orders to manufacturers.

SB70-SSA2-SA4,108,6 c. Timeliness of receiving insulin orders from manufacturers.

SB70-SSA2-SA4,108,8 3. The commissioner may contract with a nonprofit entity to develop and conduct the surveys under subds. 1. and 2. and to evaluate the survey results.

SB70-SSA2-SA4,108,11 4. No later than July 1, 2026, the commissioner shall submit to the governor and the chief clerk of each house of the legislature, for distribution to the legislature under s. 13.172 (2), a report on the results of the surveys under subds. 1. and 2.

SB70-SSA2-SA4,108,16 (9) Penalty. A manufacturer that violates this section may be required to forfeit not more than $200,000 per month of violation, with the maximum forfeiture increasing to $400,000 per month if the manufacturer continues to be in violation after 6 months and increasing to $600,000 per month if the manufacturer continues to be in violation after one year.

SB70-SSA2-SA4,107 Section 107. 632.87 (8) of the statutes is created to read:

SB70-SSA2-SA4,108,18 632.87 (8) (a) In this subsection:

SB70-SSA2-SA4,108,19 1. “Health care provider” has the meaning given in s. 146.81 (1) (a) to (hp).

SB70-SSA2-SA4,108,21 2. “Substance abuse counselor” means a substance abuse counselor certified under s. 440.88.

SB70-SSA2-SA4,109,2 (b) No policy, plan, or contract may exclude coverage for alcoholism or other drug abuse treatment or services provided by a substance abuse counselor within the scope of the substance abuse counselor's education and training if the policy, plan, or contract covers the alcoholism or other drug abuse treatment or services when provided by another health care provider.

SB70-SSA2-SA4,108 Section 108. 632.871 of the statutes is created to read:

SB70-SSA2-SA4,109,4 632.871 Telehealth services. (1) Definitions. In this section:

SB70-SSA2-SA4,109,5 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).

SB70-SSA2-SA4,109,7 (b) “Self-insured health plan” means a self-insured health plan of the state or a county, city, village, town, or school district.

SB70-SSA2-SA4,109,13 (c) “Telehealth" means a practice of health care delivery, diagnosis, consultation, treatment, or transfer of medically relevant data by means of audio, video, or data communications that are used either during a patient visit or a consultation or are used to transfer medically relevant data about a patient. “Telehealth" does not include communications delivered solely by audio-only telephone, facsimile machine, or email unless specified otherwise by rule.

SB70-SSA2-SA4,109,20 (2) Coverage denial prohibited. No disability insurance policy or self-insured health plan may deny coverage for a treatment or service provided through telehealth on the basis that the treatment or service is provided through telehealth if that treatment or service is covered by the disability insurance policy or self-insured health plan when provided in person. A disability insurance policy or self-insured health plan may limit coverage of treatments or services provided through telehealth to those treatments or services that are medically necessary.

SB70-SSA2-SA4,109,24 (3) Certain limitations on telehealth prohibited. A disability insurance policy or self-insured health plan may not subject a treatment or service provided through telehealth for which coverage is required under sub. (2) to any of the following:

SB70-SSA2-SA4,110,2 (a) Any greater deductible, copayment, or coinsurance amount than would be applicable if the treatment or service is provided in person.

SB70-SSA2-SA4,110,6 (b) Any policy or calendar year or lifetime benefit limit or other maximum limitation that is not imposed on other treatments or services covered by the disability insurance policy or self-insured health plan that are not provided through telehealth.

SB70-SSA2-SA4,110,8 (c) Prior authorization requirements that are not required for the same treatment or service when provided in person.

SB70-SSA2-SA4,110,9 (d) Unique location requirements.

SB70-SSA2-SA4,110,14 (4) Disclosure of coverage of certain telehealth services. A disability insurance policy or self-insured health plan that covers a telehealth treatment or service that has no equivalent in-person treatment or service, such as remote patient monitoring, shall specify in policy or plan materials the coverage of that telehealth treatment or service.

SB70-SSA2-SA4,9123 Section 9123. Nonstatutory provisions; Insurance.

SB70-SSA2-SA4,110,22 (1) Prescription drug importation program. The commissioner of insurance shall submit the first report required under s. 601.575 (5) by the next January 1 or July 1, whichever is earliest, that is at least 180 days after the date the prescription drug importation program is fully operational under s. 601.575 (4). The commissioner of insurance shall include in the first 3 reports submitted under s. 601.575 (5) information on the implementation of the audit functions under s. 601.575 (1) (n).

SB70-SSA2-SA4,111,2 (2) Public option health insurance plan. The office of the commissioner of insurance may expend from the appropriation under s. 20.145 (1) (a) in fiscal year 2023-24 not more than $1,000,000 for the development of a public option health insurance plan.

SB70-SSA2-SA4,111,5 (3) Prescription drug purchasing entity. During the 2023-2025 fiscal biennium, the office of the commissioner of insurance shall conduct a study on the viability of creating or implementing a state prescription drug purchasing entity.

SB70-SSA2-SA4,9323 Section 9323. Initial applicability; Insurance.

SB70-SSA2-SA4,111,7 (1) Telehealth parity.

SB70-SSA2-SA4,111,11 (a) For policies and plans containing provisions inconsistent with the treatment of s. 632.871, the treatment of s. 632.871 first applies to policy or plan years beginning on January 1 of the year following the year in which this paragraph takes effect, except as provided in par. (b ).

SB70-SSA2-SA4,111,16 (b) For policies and plans that are affected by a collective bargaining agreement containing provisions inconsistent with the treatment of s. 632.871, the treatment of s. 632.871 first applies to policy or plan years beginning on the effective date of this paragraph or on the day on which the collective bargaining agreement is newly established, extended, modified, or renewed, whichever is later.

SB70-SSA2-SA4,111,17 (2) Substance abuse counselor coverage.

SB70-SSA2-SA4,111,21 (a) For policies and plans containing provisions inconsistent with the treatment of s. 632.87 (8), the treatment of s. 632.87 (8) first applies to policy or plan years beginning on January 1 of the year following the year in which this paragraph takes effect, except as provided in par. (b ).

SB70-SSA2-SA4,112,2 (b) For policies and plans that are affected by a collective bargaining agreement containing provisions inconsistent with the treatment of s. 632.87 (8), the treatment of s. 632.87 (8) first applies to policy or plan years beginning on the effective date of this paragraph or on the day on which the collective bargaining agreement is newly established, extended, modified, or renewed, whichever is later.

SB70-SSA2-SA4,112,3 (3) Application of manufacturer discounts.

SB70-SSA2-SA4,112,7 (a) For policies and plans containing provisions inconsistent with the treatment of s. 632.862, the treatment of s. 632.862 first applies to policy or plan years beginning on January 1 of the year following the year in which this paragraph takes effect, except as provided in par. (b ).

SB70-SSA2-SA4,112,12 (b) For policies or plans that are affected by a collective bargaining agreement containing provisions inconsistent with the treatment of s. 632.862, the treatment of s. 632.862 first applies to policy or plan years beginning on the effective date of this paragraph or on the day on which the collective bargaining agreement is newly established, extended, modified, or renewed, whichever is later.

SB70-SSA2-SA4,9423 Section 9423. Effective dates; Insurance.

SB70-SSA2-SA4,112,16 (1) Substance abuse counselor coverage. The treatment of s. 632.87 (8) and Section 9323 (2 ) of this act take effect on the first day of the 4th month beginning after publication.”.

SB70-SSA2-SA4,112,17 157. Page 374, line 11: after that line insert:

SB70-SSA2-SA4,112,19 “ Section 109. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table - See PDF for table

SB70-SSA2-SA4,110 Section 110. 20.435 (1) (fL) of the statutes is created to read:

SB70-SSA2-SA4,113,4 20.435 (1) (fL) Nurse aide training and recruitment grants. The amounts in the schedule for grants to train and recruit individuals to work as nurse aides in nursing homes under s. 146.41.

SB70-SSA2-SA4,111 Section 111. 146.41 of the statutes is created to read:

SB70-SSA2-SA4,113,6 146.41 Nurse aide training and recruitment grants. (1) In this section:

SB70-SSA2-SA4,113,7 (a) “Nurse aide” has the meaning given in s. 146.40 (1) (d).

SB70-SSA2-SA4,113,8 (b) “Nursing home" has the meaning given in s. 50.01 (3).

SB70-SSA2-SA4,113,11 (2) Beginning in fiscal year 2024-25, the department shall award grants to train and recruit individuals to work as nurse aides in nursing homes. The grants awarded under this subsection shall include grants for all of the following:

SB70-SSA2-SA4,113,13 (a) The cost for an individual to complete an instructional program for nurse aides in a program approved under s. 146.40 (3) and (3g).

SB70-SSA2-SA4,113,15 (b) The cost for an individual to complete a competency evaluation for nurse aides in a program approved under s. 146.40 (3m).

SB70-SSA2-SA4,113,17 (c) A retention bonus for an individual who has worked for at least 6 months as a nurse aide in a nursing home.

SB70-SSA2-SA4,113,21 (3) The department may partner with nonprofit organizations, private entities, the board on aging and long term care, and the technical college system board to award the grants under sub. (2) and recruit individuals to work as nurse aides in nursing homes.”.

SB70-SSA2-SA4,113,22 158. Page 374, line 11: after that line insert:

SB70-SSA2-SA4,114,1 “ Section 112. 20.250 (2) (title) of the statutes is amended to read:

SB70-SSA2-SA4,114,2 20.250 (2) (title) Research and community support.

SB70-SSA2-SA4,113 Section 113. 20.250 (2) (a) of the statutes is created to read:

SB70-SSA2-SA4,114,7 20.250 (2) (a) Violence prevention grants. Biennially, the amounts in the schedule to make violence prevention grants supporting local, evidence-informed activities that enhance the safety and well-being of children, youth, and families throughout this state.”.

SB70-SSA2-SA4,114,8 159. Page 374, line 11: after that line insert: