AB50-ASA2-AA8,21,11102. The penalties assessed under sub. (9) during the previous calendar year, 11including the name of the manufacturer and amount of the penalty. AB50-ASA2-AA8,21,1612(8) Additional responsibilities of commissioner. (a) Application form. 13The commissioner shall make the application form described in sub. (2) (c) 1. a. 14available on the office’s website and shall make the form available to pharmacies 15and health care providers who prescribe or dispense insulin, hospital emergency 16departments, urgent care clinics, and community health clinics. AB50-ASA2-AA8,21,1917(b) Public outreach. 1. The commissioner shall conduct public outreach to 18create awareness of the urgent need safety net programs and patient assistance 19programs. AB50-ASA2-AA8,21,21202. The commissioner shall develop and make available on the office’s website 21an information sheet that contains all of the following information: AB50-ASA2-AA8,21,2322a. A description of how to access insulin through an urgent need safety net 23program. AB50-ASA2-AA8,22,2
1b. A description of how to access insulin through a patient assistance 2program. AB50-ASA2-AA8,22,43c. Information on how to contact a navigator for assistance in accessing 4insulin through an urgent need safety net program or patient assistance program. AB50-ASA2-AA8,22,65d. Information on how to contact the commissioner if a manufacturer 6determines that an individual is not eligible for a patient assistance program. AB50-ASA2-AA8,22,87e. A notification that an individual may contact the commissioner for more 8information or assistance in accessing ongoing affordable insulin options. AB50-ASA2-AA8,22,159(c) Navigators. The commissioner shall develop a training program to provide 10navigators with information and the resources necessary to assist individuals in 11accessing appropriate long-term insulin options. The commissioner shall compile a 12list of navigators that have completed the training program and are available to 13assist individuals in accessing affordable insulin coverage options. The list shall be 14made available on the office’s website and to pharmacies and health care 15practitioners who dispense and prescribe insulin. AB50-ASA2-AA8,22,2116(d) Satisfaction surveys. 1. The commissioner shall develop and conduct a 17satisfaction survey of individuals who have accessed insulin through urgent need 18safety net programs and patient assistance programs. The survey shall ask 19whether the individual is still in need of a long-term solution for affordable insulin 20and shall include questions about the individual’s satisfaction with all of the 21following, if applicable: AB50-ASA2-AA8,22,2222a. Accessibility to urgent-need insulin. AB50-ASA2-AA8,23,2
1b. Adequacy of the information sheet and list of navigators received from the 2pharmacy. AB50-ASA2-AA8,23,33c. Helpfulness of a navigator. AB50-ASA2-AA8,23,54d. Ease of access in applying for a patient assistance program and receiving 5insulin from the pharmacy under the patient assistance program. AB50-ASA2-AA8,23,962. 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: AB50-ASA2-AA8,23,1110a. Timeliness of reimbursement from manufacturers for insulin dispensed by 11the pharmacy under urgent need safety net programs. AB50-ASA2-AA8,23,1212b. Ease in submitting insulin orders to manufacturers. AB50-ASA2-AA8,23,1313c. Timeliness of receiving insulin orders from manufacturers. AB50-ASA2-AA8,23,15143. 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. AB50-ASA2-AA8,23,18164. No later than July 1, 2028, 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. AB50-ASA2-AA8,23,2319(9) Penalty. A manufacturer that violates this section may be required to 20forfeit not more than $200,000 per month of violation, with the maximum forfeiture 21increasing to $400,000 per month if the manufacturer continues to be in violation 22after 6 months and increasing to $600,000 per month if the manufacturer continues 23to be in violation after one year.”. AB50-ASA2-AA8,24,53609.83 Coverage of drugs and devices. Limited service health 4organizations, preferred provider plans, and defined network plans are subject to 5ss. 632.853, 632.861, and 632.895 (6) (b), (16t), and (16v). AB50-ASA2-AA8,156Section 15. 632.895 (6) (title) of the statutes is amended to read: AB50-ASA2-AA8,24,87632.895 (6) (title) Equipment and supplies for treatment of diabetes; 8insulin. AB50-ASA2-AA8,169Section 16. 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and 10amended to read: AB50-ASA2-AA8,24,2111632.895 (6) (a) Every disability insurance policy which that provides coverage 12of expenses incurred for treatment of diabetes shall provide coverage for expenses 13incurred by the installation and use of an insulin infusion pump, coverage for all 14other equipment and supplies, including insulin or any other prescription 15medication, used in the treatment of diabetes, and coverage of diabetic self-16management education programs. Coverage Except as provided in par. (b), 17coverage required under this subsection shall be subject to the same exclusions, 18limitations, deductibles, and coinsurance provisions of the policy as other covered 19expenses, except that insulin infusion pump coverage may be limited to the 20purchase of one pump per year and the insurer may require the insured to use a 21pump for 30 days before purchase. AB50-ASA2-AA8,1722Section 17. 632.895 (6) (b) of the statutes is created to read: AB50-ASA2-AA8,24,2323632.895 (6) (b) 1. In this paragraph: AB50-ASA2-AA8,25,3
1a. “Cost sharing” means the total of any deductible, copayment, or 2coinsurance amounts imposed on a person covered under a disability insurance 3policy or self-insured health plan. AB50-ASA2-AA8,25,44b. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c). AB50-ASA2-AA8,25,752. Every disability insurance policy and self-insured health plan that covers 6insulin and imposes cost sharing on prescription drugs may not impose cost sharing 7on insulin in an amount that exceeds $35 for a one-month supply of insulin. AB50-ASA2-AA8,25,1183. Nothing in this paragraph prohibits a disability insurance policy or self-9insured health plan from imposing cost sharing on insulin in an amount less than 10the amount specified under subd. 2. Nothing in this paragraph requires a disability 11insurance policy or self-insured health plan to impose any cost sharing on insulin. AB50-ASA2-AA8,25,1613(1) Cost-sharing cap on insulin. The treatment of ss. 609.83 and 632.895 14(6) (title), the renumbering and amendment of s. 632.895 (6), and the creation of s. 15632.895 (6) (b) take effect on the first day of the 4th month beginning after 16publication.”. AB50-ASA2-AA8,25,231940.51 (8) Every health care coverage plan offered by the state under sub. (6) 20shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.722, 21632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 22632.85, 632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (3) to (6), 632.885, 23632.89, 632.895 (5m) and (8) to (17), and 632.896. AB50-ASA2-AA8,26,5240.51 (8m) Every health care coverage plan offered by the group insurance 3board under sub. (7) shall comply with ss. 631.95, 632.722, 632.729, 632.746 (1) to 4(8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 5632.861, 632.862, 632.867, 632.885, 632.89, and 632.895 (11) to (17). AB50-ASA2-AA8,26,13766.0137 (4) Self-insured health plans. If a city, including a 1st class city, 8or a village provides health care benefits under its home rule power, or if a town 9provides health care benefits, to its officers and employees on a self-insured basis, 10the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 11632.722, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 12632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (4) to (6), 632.885, 632.89, 13632.895 (9) to (17), 632.896, and 767.513 (4). AB50-ASA2-AA8,2114Section 21. 120.13 (2) (g) of the statutes is amended to read: AB50-ASA2-AA8,26,1815120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 1649.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.722, 632.729, 632.746 (10) (a) 2. and 17(b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.862, 632.867, 18632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4). AB50-ASA2-AA8,2219Section 22. 185.983 (1) (intro.) of the statutes is amended to read: AB50-ASA2-AA8,27,320185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a 21cooperative association organized under s. 185.981 shall be exempt from chs. 600 to 22646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 23601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93, 24631.95, 632.72 (2), 632.722, 632.729, 632.745 to 632.749, 632.775, 632.79, 632.795,
1632.798, 632.85, 632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (2) to (6), 2632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 3620, 630, 635, 645, and 646, but the sponsoring association shall: AB50-ASA2-AA8,27,85609.83 Coverage of drugs and devices; application of payments. 6Limited service health organizations, preferred provider plans, and defined 7network plans are subject to ss. 632.853, 632.861, 632.862, and 632.895 (16t) and 8(16v). AB50-ASA2-AA8,27,1110632.862 Application of prescription drug payments. (1) Definitions. 11In this section: AB50-ASA2-AA8,27,1212(a) “Brand name” has the meaning given in s. 450.12 (1) (a). AB50-ASA2-AA8,27,1313(b) “Brand name drug” means any of the following: AB50-ASA2-AA8,27,15141. A prescription drug that contains a brand name and that has no generic 15equivalent. AB50-ASA2-AA8,27,20162. A prescription drug that contains a brand name and has a generic 17equivalent but for which the enrollee has received prior authorization from the 18insurer offering the disability insurance policy or self-insured health plan or 19authorization from a physician to obtain the prescription drug under the disability 20insurance policy or self-insured health plan. AB50-ASA2-AA8,27,2121(c) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a). AB50-ASA2-AA8,27,2222(d) “Prescription drug” has the meaning given in s. 450.01 (20). AB50-ASA2-AA8,28,2
1(e) “Self-insured health plan” means a self-insured health plan of the state or 2a county, city, village, town, or school district. AB50-ASA2-AA8,28,83(2) Application of discounts. A disability insurance policy that offers a 4prescription drug benefit or a self-insured health plan shall apply to any calculation 5of an out-of-pocket maximum amount and to any deductible of the disability 6insurance policy or self-insured health plan for an enrollee the amount that any 7discount provided by the manufacturer of a brand name drug reduces the cost 8sharing amount charged to the enrollee for that brand name drug. AB50-ASA2-AA8,28,1010(1) Application of manufacturer discounts. AB50-ASA2-AA8,28,1611(a) For policies and plans containing provisions inconsistent with the 12treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 13609.83, and 632.862, the treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) 14(g), 185.983 (1) (intro.), 609.83, and 632.862 first applies to policy or plan years 15beginning on January 1 of the year following the year in which this paragraph takes 16effect, except as provided in par. (b). AB50-ASA2-AA8,28,2317(b) For policies or plans that are affected by a collective bargaining agreement 18containing provisions inconsistent with the treatment of ss. 40.51 (8) and (8m), 1966.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.83, and 632.862, the treatment of 20ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.83, and 21632.862 first applies to policy or plan years beginning on the effective date of this 22paragraph or on the day on which the collective bargaining agreement is newly 23established, extended, modified, or renewed, whichever is later. AB50-ASA2-AA8,29,52(1) Application of manufacturer discounts. The treatment of ss. 40.51 (8) 3and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.83, and 632.862 and 4Section 9323 (1) take effect on the first day of the 4th month beginning after 5publication.”. AB50-ASA2-AA8,29,147“Section 25. 20.005 (3) (schedule) of the statutes: at the appropriate place, 8insert the following amounts for the purposes indicated: AB50-ASA2-AA8,2615Section 26. 20.115 (4) (aq) of the statutes is created to read: AB50-ASA2-AA8,29,181620.115 (4) (aq) Food security and Wisconsin products grants. As a continuing 17appropriation, the amounts in the schedule for food security and Wisconsin 18products grants under s. 93.62. AB50-ASA2-AA8,30,22093.62 Food security and Wisconsin products grant program. The 21department may award grants from the appropriation under s. 20.115 (4) (aq) to 22nonprofit food banks, nonprofit food pantries, and other nonprofit organizations
1that provide food assistance for the purpose of purchasing food products that are 2made or grown in this state.”. AB50-ASA2-AA8,30,75609.712 Essential health benefits; preventive services. Defined 6network plans and preferred provider plans are subject to s. 632.895 (13m) and 7(14m). AB50-ASA2-AA8,30,119609.847 Preexisting condition discrimination and certain benefit 10limits prohibited. Limited service health organizations, preferred provider 11plans, and defined network plans are subject to s. 632.728. AB50-ASA2-AA8,3012Section 30. 625.12 (1) (a) of the statutes is amended to read: AB50-ASA2-AA8,30,1413625.12 (1) (a) Past and prospective loss and expense experience within and 14outside of this state, except as provided in s. 632.728. AB50-ASA2-AA8,3115Section 31. 625.12 (1) (e) of the statutes is amended to read: AB50-ASA2-AA8,30,1716625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors, 17including the judgment of technical personnel. AB50-ASA2-AA8,31,419625.12 (2) Classification. Except as provided in s. ss. 632.728 and 632.729, 20risks may be classified in any reasonable way for the establishment of rates and 21minimum premiums, except that no classifications may be based on race, color, 22creed or national origin, and classifications in automobile insurance may not be 23based on physical condition or developmental disability as defined in s. 51.01 (5).
1Subject to ss. 632.365, 632.728, and 632.729, rates thus produced may be modified 2for individual risks in accordance with rating plans or schedules that establish 3reasonable standards for measuring probable variations in hazards, expenses, or 4both. Rates may also be modified for individual risks under s. 625.13 (2). AB50-ASA2-AA8,31,136625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may 7itself establish rates and supplementary rate information for one or more market 8segments based on the factors in s. 625.12 and, if the rates are for motor vehicle 9liability insurance, subject to s. 632.365, or the insurer may use rates and 10supplementary rate information prepared by a rate service organization, with 11average expense factors determined by the rate service organization or with such 12modification for its own expense and loss experience as the credibility of that 13experience allows. AB50-ASA2-AA8,3414Section 34. 628.34 (3) (a) of the statutes is amended to read: AB50-ASA2-AA8,31,2215628.34 (3) (a) No insurer may unfairly discriminate among policyholders by 16charging different premiums or by offering different terms of coverage except on the 17basis of classifications related to the nature and the degree of the risk covered or the 18expenses involved, subject to ss. 632.365, 632.728, 632.729, 632.746, and 632.748. 19Rates are not unfairly discriminatory if they are averaged broadly among persons 20insured under a group, blanket or franchise policy, and terms are not unfairly 21discriminatory merely because they are more favorable than in a similar individual 22policy.
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