AB50: Bill Text

AB50,1466,11 (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:

AB50,1466,12 1. The information provided to the commissioner under par. (a).

AB50,1466,14 2. The penalties assessed under sub. (9) during the previous calendar year, including the name of the manufacturer and amount of the penalty.

AB50,1466,19 (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.

AB50,1466,22 (b) Public outreach. 1. The commissioner shall conduct public outreach to create awareness of the urgent need safety net programs and patient assistance programs.

AB50,1467,2 2. The commissioner shall develop and make available on the office’s website an information sheet that contains all of the following information:

AB50,1467,4 a. A description of how to access insulin through an urgent need safety net program.

AB50,1467,6 b. A description of how to access insulin through a patient assistance program.

AB50,1467,8 c. Information on how to contact a navigator for assistance in accessing insulin through an urgent need safety net program or patient assistance program.

AB50,1467,10 d. Information on how to contact the commissioner if a manufacturer determines that an individual is not eligible for a patient assistance program.

AB50,1467,12 e. A notification that an individual may contact the commissioner for more information or assistance in accessing ongoing affordable insulin options.

AB50,1467,19 (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.

AB50,1468,2 (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:

AB50,1468,3 a. Accessibility to urgent-need insulin.

AB50,1468,5 b. Adequacy of the information sheet and list of navigators received from the pharmacy.

AB50,1468,6 c. Helpfulness of a navigator.

AB50,1468,8 d. Ease of access in applying for a patient assistance program and receiving insulin from the pharmacy under the patient assistance program.

AB50,1468,12 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:

AB50,1468,14 a. Timeliness of reimbursement from manufacturers for insulin dispensed by the pharmacy under urgent need safety net programs.

AB50,1468,15 b. Ease in submitting insulin orders to manufacturers.

AB50,1468,16 c. Timeliness of receiving insulin orders from manufacturers.

AB50,1468,18 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.

AB50,1468,21 4. No later than July 1, 2028, 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.

AB50,1469,3 (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.

AB50,2948 Section 2948. 632.869 of the statutes is created to read:

AB50,1469,6 632.869 Reimbursement to federal drug pricing program participants. (1) In this section:

AB50,1469,11 (a) “Covered entity” means an entity described in 42 USC 256b (a) (4) (A), (D), (E), (J), or (N) that participates in the federal drug pricing program under 42 USC 256b, a pharmacy of the entity, or a pharmacy contracted with the entity to dispense drugs purchased through the federal drug pricing program under 42 USC 256b.

AB50,1469,12 (b) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

AB50,1469,14 (2) No person, including a pharmacy benefit manager or 3rd-party payer, may do any of the following:

AB50,1469,18 (a) Reimburse a covered entity for a drug that is subject to an agreement under 42 USC 256b at a rate lower than that paid for the same drug to pharmacies that are not covered entities and have a similar prescription volume to that of the covered entity.

AB50,1469,21 (b) Assess a covered entity any fee, charge back, or other adjustment on the basis of the covered entity’s participation in the federal drug pricing program under 42 USC 256b.

AB50,1470,2 (3) The commissioner may promulgate rules to implement this section and to establish minimum reimbursement rates for covered entities and any other entity described under 42 USC 256b (a) (4).

AB50,2949 Section 2949. 632.87 (1) of the statutes is amended to read:

AB50,1470,8 632.87 (1) No insurer may refuse to provide or pay for benefits for health care services provided by a licensed health care professional on the ground that the services were not rendered by a physician as defined in s. 990.01 (28), unless the contract clearly excludes services by such practitioners, but no contract or plan may exclude services in violation of sub. (2), (2m), (3), (4), (4e), (4m), (5), or (6).

AB50,2950 Section 2950. 632.87 (4) of the statutes is amended to read:

AB50,1470,14 632.87 (4) No policy, plan or contract may exclude coverage for diagnosis and treatment of a condition or complaint by a licensed dentist or dental therapist within the scope of the dentist’s or dental therapist’s license, if the policy, plan or contract covers diagnosis and treatment of the condition or complaint by another health care provider, as defined in s. 146.81 (1) (a) to (p).

AB50,2951 Section 2951. 632.87 (4e) of the statutes is created to read:

AB50,1470,17 632.87 (4e) In this subsection, “dental therapist” means an individual licensed under s. 447.04 (1m).

AB50,1470,22 (b) No policy, plan, or contract may exclude coverage for dental services, treatments, or procedures provided by a dental therapist within the scope of the dental therapist’s license if the policy, plan, or contract covers the dental services, treatments, or procedures when provided by another health care provider, as defined in s. 146.81 (1) (a) to (hp).

AB50,2952 Section 2952. 632.87 (7) of the statutes is created to read:

AB50,1470,24 632.87 (7) (a) In this subsection:

AB50,1471,1 1. “Health care provider” has the meaning given in s. 146.81 (1) (a) to (hp).

AB50,1471,3 2. “Qualified treatment trainee” has the meaning given in s. DHS 35.03 (17m), Wis. Adm. Code.

AB50,1471,8 (b) No policy, plan, or contract may exclude coverage for mental health or behavioral health treatment or services provided by a qualified treatment trainee within the scope of the qualified treatment trainee’s education and training if the policy, plan, or contract covers the mental health or behavioral health treatment or services when provided by another health care provider.

AB50,2953 Section 2953. 632.87 (8) of the statutes is created to read:

AB50,1471,10 632.87 (8) (a) In this subsection:

AB50,1471,11 1. “Health care provider” has the meaning given in s. 146.81 (1) (a) to (hp).

AB50,1471,13 2. “Substance abuse counselor” means a substance abuse counselor certified under s. 440.88.

AB50,1471,18 (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.

AB50,2954 Section 2954. 632.871 of the statutes is created to read:

AB50,1471,20 632.871 Telehealth services. (1) Definitions. In this section:

AB50,1471,21 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).

AB50,1471,23 (b) “Self-insured health plan” means a self-insured health plan of the state or a county, city, village, town, or school district.

AB50,1472,6 (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.

AB50,1472,13 (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.

AB50,1472,17 (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:

AB50,1472,19 (a) Any greater deductible, copayment, or coinsurance amount than would be applicable if the treatment or service is provided in person.

AB50,1472,23 (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.

AB50,1473,2 (c) Prior authorization requirements that are not required for the same treatment or service when provided in person.

AB50,1473,3 (d) Unique location requirements.

AB50,1473,8 (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.

AB50,2955 Section 2955. 632.891 of the statutes is created to read:

AB50,1473,14 632.891 Coverage without prior authorization for inpatient mental health services. A disability insurance policy, as defined in s. 632.895 (1) (a), or self-insured health plan, as defined in s. 632.745 (24), that covers inpatient mental health services may not require prior authorization for the provision or coverage of those services.

AB50,2956 Section 2956. 632.895 (6) (title) of the statutes is amended to read:

AB50,1473,17 632.895 (6) (title) Equipment and supplies for treatment of diabetes; insulin.

AB50,2957 Section 2957. 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and amended to read:

AB50,1474,6 632.895 (6) (a) Every disability insurance policy which that provides coverage of expenses incurred for treatment of diabetes shall provide coverage for expenses incurred by the installation and use of an insulin infusion pump, coverage for all other equipment and supplies, including insulin or any other prescription medication, used in the treatment of diabetes, and coverage of diabetic self- management education programs. Coverage Except as provided in par. (b), coverage required under this subsection shall be subject to the same exclusions, limitations, deductibles, and coinsurance provisions of the policy as other covered expenses, except that insulin infusion pump coverage may be limited to the purchase of one pump per year and the insurer may require the insured to use a pump for 30 days before purchase.

AB50,2958 Section 2958. 632.895 (6) (b) of the statutes is created to read:

AB50,1474,8 632.895 (6) (b) 1. In this paragraph:

AB50,1474,11 a. “Cost sharing” means the total of any deductible, copayment, or coinsurance amounts imposed on a person covered under a disability insurance policy or self-insured health plan.

AB50,1474,12 b. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB50,1474,15 2. Every disability insurance policy and self-insured health plan that covers insulin and imposes cost sharing on prescription drugs may not impose cost sharing on insulin in an amount that exceeds $35 for a one-month supply of insulin.

AB50,1474,19 3. Nothing in this paragraph prohibits a disability insurance policy or self- insured health plan from imposing cost sharing on insulin in an amount less than the amount specified under subd. 2. Nothing in this paragraph requires a disability insurance policy or self-insured health plan to impose any cost sharing on insulin.

AB50,2959 Section 2959. 632.895 (8) (d) of the statutes is amended to read:

AB50,1475,4 632.895 (8) (d) Coverage is required under this subsection despite whether the woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c), and (e), coverage under this subsection may only be subject to exclusions and limitations, including deductibles, copayments and restrictions on excessive charges, that are applied to other radiological examinations covered under the disability insurance policy. Coverage under this subsection may not be subject to any deductibles, copayments, or coinsurance.

AB50,2960 Section 2960. 632.895 (13m) of the statutes is created to read:

AB50,1475,7 632.895 (13m) Preventive services. (a) In this section, “self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB50,1475,10 (b) Every disability insurance policy, except any disability insurance policy that is described in s. 632.745 (11) (b) 1. to 12., and every self-insured health plan shall provide coverage for all of the following preventive services:

AB50,1475,11 1. Mammography in accordance with sub. (8).

AB50,1475,13 2. Genetic breast cancer screening and counseling and preventive medication for adult women at high risk for breast cancer.

AB50,1475,15 3. Papanicolaou test for cancer screening for women 21 years of age or older with an intact cervix.

AB50,1475,17 4. Human papillomavirus testing for women who have attained the age of 30 years but have not attained the age of 66 years.

AB50,1475,18 5. Colorectal cancer screening in accordance with sub. (16m).

AB50,1475,21 6. Annual tomography for lung cancer screening for adults who have attained the age of 55 years but have not attained the age of 80 years and who have health histories demonstrating a risk for lung cancer.

AB50,1475,23 7. Skin cancer screening for individuals who have attained the age of 10 years but have not attained the age of 22 years.

AB50,1476,2 8. Counseling for skin cancer prevention for adults who have attained the age of 18 years but have not attained the age of 25 years.

AB50,1476,4 9. Abdominal aortic aneurysm screening for men who have attained the age of 65 years but have not attained the age of 75 years and who have ever smoked.

AB50,1476,7 10. Hypertension screening for adults and blood pressure testing for adults, for children under the age of 3 years who are at high risk for hypertension, and for children 3 years of age or older.

AB50,1476,9 11. Lipid disorder screening for minors 2 years of age or older, adults 20 years of age or older at high risk for lipid disorders, and all men 35 years of age or older.