February 26, 2025 - Introduced by Senators James, Cabral-Guevara and Wanggaard, cosponsored by Representatives Novak, Gundrum, B. Jacobson, Mursau, Sortwell, Steffen and Tittl. Referred to Committee on Mental Health, Substance Abuse Prevention, Children and Families.
SB83,1,3
1An Act to create 49.45 (9o) of the statutes; relating to: utilization
2management controls for antipsychotic prescription drugs under the Medical
3Assistance program. Analysis by the Legislative Reference Bureau
This bill prohibits the Department of Health Services from imposing any utilization management controls for prescription drugs under the Medical Assistance program that are approved by the federal Food and Drug Administration and are classified as antipsychotic. Utilization management controls are formal techniques used by a health carrier or prescription drug utilization management entity that are designed to evaluate prescription drug medical necessity, appropriateness, efficacy, or efficiency. Currently, DHS administers the Medical Assistance program, which is a joint federal and state program that provides health services to individuals who have limited financial resources.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SB83,1
1Section 1. 49.45 (9o) of the statutes is created to read: SB83,2,3249.45 (9o) Utilization management controls for antipsychotic 3prescription drugs. (a) In this subsection: SB83,2,441. “Prescription drug” has the meaning given in s. 450.01 (20). SB83,2,852. “Utilization management controls” means a set of formal techniques used 6by a health carrier or prescription drug utilization management entity that are 7designed to evaluate prescription drug medical necessity, appropriateness, efficacy, 8or efficiency, including prior authorization and step therapy protocols. SB83,2,119(b) The department may not impose utilization management controls for any 10prescription drug that is approved by the federal food and drug administration and 11is classified as an antipsychotic.
