Amendment SSA1-AB68

AB68-SSA1,1315,24 601.415 (14) Patient pharmacy benefits tool. (a) From the appropriation under s. 20.145 (1) (a), beginning in the 2022-23 fiscal year, the office shall award grants in a total amount of up to $500,000 each fiscal year to health care providers to develop and implement a tool for prescribers to disclose the cost of prescription drugs for patients. The tool must be usable by physicians and other prescribers to determine the cost of prescription drugs for their patients.

AB68-SSA1,1316,2 (b) Any health care provider that receives a grant under par. (a) shall contribute matching funds equal to at least 50 percent of the grant amount awarded.

AB68-SSA1,2954 Section 2954 . 601.46 (3) (b) of the statutes is amended to read:

AB68-SSA1,1316,6 601.46 (3) (b) A general review of the insurance business in this state, including a report on emerging regulatory problems, developments and trends , including trends related to prescription drugs;

AB68-SSA1,2955 Section 2955. 601.575 of the statutes is created to read:

AB68-SSA1,1316,13 601.575 Prescription drug importation program. (1) Importation program requirements. The commissioner, in consultation with persons interested in the sale and pricing of prescription drugs and appropriate officials and agencies of the federal government, shall design and implement a prescription drug importation program for the benefit of residents of this state, that generates savings for residents, and that satisfies all of the following:

AB68-SSA1,1316,16 (a) The commissioner shall designate a state agency to become a licensed wholesale distributor or to contract with a licensed wholesale distributor and shall seek federal certification and approval to import prescription drugs.

AB68-SSA1,1316,19 (b) The prescription drug importation program under this section shall comply with relevant requirements of 21 USC 384, including safety and cost savings requirements.

AB68-SSA1,1316,22 (c) The prescription drug importation program under this section shall import prescription drugs from Canadian suppliers regulated under any appropriate Canadian or provincial laws.

AB68-SSA1,1316,25 (d) The prescription drug importation program under this section shall have a process to sample the purity, chemical composition, and potency of imported prescription drugs.

AB68-SSA1,1317,4 (e) The prescription drug importation program under this section shall import only those prescription drugs for which importation creates substantial savings for residents of the state and only those prescription drugs that are not brand-name drugs and that have fewer than 4 competitor prescription drugs in the United States.

AB68-SSA1,1317,7 (f) The commissioner shall ensure that prescription drugs imported under the program under this section are not distributed, dispensed, or sold outside of the state.

AB68-SSA1,1317,9 (g) The prescription drug importation program under this section shall ensure all of the following:

AB68-SSA1,1317,11 1. Participation by any pharmacy or health care provider in the program is voluntary.

AB68-SSA1,1317,13 2. Any pharmacy or health care provider participating in the program has the appropriate license or other credential in this state.

AB68-SSA1,1317,16 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.

AB68-SSA1,1317,20 (h) The prescription drug importation program under this section 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.

AB68-SSA1,1317,23 (i) The prescription drug importation program under this section shall ensure that any health plan or health insurance policy participating in the program does all of the following:

AB68-SSA1,1317,25 1. Maintains a formulary and claims payment system with current information on prescription drugs imported under the program.

AB68-SSA1,1318,3 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.

AB68-SSA1,1318,6 3. Demonstrates to the commissioner or a state agency designated by the commissioner how premiums under the policy or plan are affected by savings on prescription drugs imported under the program.

AB68-SSA1,1318,9 (j) Any wholesale distributor importing prescription drugs under the program under this section shall limit its profit margin to the amount established by the commissioner or a state agency designated by the commissioner.

AB68-SSA1,1318,12 (k) The prescription drug importation program under this section may not import any generic prescription drug that would violate federal patent laws on branded products in this country.

AB68-SSA1,1318,17 (L) The prescription drug importation program under this section shall comply to the extent practical and feasible, before the prescription drug to be imported comes into the possession of the state's wholesale distributor and fully after the prescription drug to be imported is in the possession of the state's wholesale distributor, with tracking and tracing requirements of 21 USC 360eee to 360eee-1.

AB68-SSA1,1318,20 (m) The prescription drug importation program under this section shall establish a fee or other mechanism to finance the program that does not jeopardize significant savings to residents of the state.

AB68-SSA1,1318,22 (n) The prescription drug importation program under this section shall have an audit function that ensures all of the following:

AB68-SSA1,1318,25 1. The commissioner has a sound methodology to determine the most cost-effective prescription drugs to include in the importation program under this section.

AB68-SSA1,1319,2 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.

AB68-SSA1,1319,4 3. Prescription drugs imported under the program are pure, unadulterated, potent, and safe.

AB68-SSA1,1319,6 4. The prescription drug importation program is complying with the requirements of this subsection.

AB68-SSA1,1319,9 5. The prescription drug importation program under this section is adequately financed to support administrative functions of the program while generating significant cost savings to residents of the state.

AB68-SSA1,1319,11 6. The prescription drug importation program under this section does not put residents of the state at a higher risk than if the program did not exist.

AB68-SSA1,1319,13 7. The prescription drug importation program under this section provides and is projected to continue to provide substantial cost savings to residents of the state.

AB68-SSA1,1319,16 (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.

AB68-SSA1,1320,2 (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 prescription drug importation program to the federal department of health and human services unless the joint committee on finance approves the proposed prescription drug implementation program. Within 14 days of the date of approval by the joint committee on finance of the proposed prescription drug importation program, the commissioner shall submit to the federal department of health and human services a request for certification of the approved prescription drug importation program.

AB68-SSA1,1320,10 (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 prescription drug importation 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:

AB68-SSA1,1320,13 (a) Become a licensed wholesale distributor, designate another state agency to become a licensed wholesale distributor, or contract with a licensed wholesale distributor.

AB68-SSA1,1320,15 (b) Contract with one or more Canadian suppliers that meet the criteria in sub. (1) (c) and (n).

AB68-SSA1,1320,19 (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 the state on participating in the prescription drug importation program.

AB68-SSA1,1320,22 (d) Develop and implement a registration process for health plans and health insurance policies, pharmacies, and health care providers interested in participating in the prescription drug importation program.

AB68-SSA1,1320,24 (e) Create a publicly accessible source for listing prices of prescription drugs imported under the program.

AB68-SSA1,1321,3 (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.

AB68-SSA1,1321,5 (g) Establish the audit functions under sub. (1) (n) with a timeline to complete each audit function every 2 years.

AB68-SSA1,1321,8 (h) Conduct any other activities determined by the commissioner to be important to successful implementation of the prescription drug importation program under this section.

AB68-SSA1,1321,10 (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:

AB68-SSA1,1321,12 (a) A list of prescription drugs included in the importation program under this section.

AB68-SSA1,1321,15 (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.

AB68-SSA1,1321,20 (c) The estimated amount of savings to residents of the 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.

AB68-SSA1,1321,22 (d) Findings of any audit functions under sub. (1) (n) completed since the date of the previous report under this subsection.

AB68-SSA1,1321,24 (6) Rulemaking. The commissioner may promulgate any rules necessary to implement this section.

AB68-SSA1,2956 Section 2956. 601.59 of the statutes is created to read:

AB68-SSA1,1322,1 601.59 State-based exchange. (1) Definitions. In this section:

AB68-SSA1,1322,2 (a) “Exchange” has the meaning given in 45 CFR 155.20.

AB68-SSA1,1322,5 (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.

AB68-SSA1,1322,9 (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.

AB68-SSA1,1322,16 (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.

AB68-SSA1,1322,19 (3) Agreement with federal government. The commissioner may enter into any agreement with the federal government necessary to facilitate the implementation of this section.

AB68-SSA1,1322,25 (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 where enrollment is through the exchange:

AB68-SSA1,1323,2 (a) For any plan year for which the commissioner operates a state-based exchange on the federal platform, the rate is 0.5 percent.

AB68-SSA1,1323,4 (b) For the first 2 plan years for which the commissioner operates a state-based exchange without the federal platform, the rate is 3 percent.

AB68-SSA1,1323,7 (c) Beginning with the 3rd plan year for which the commissioner operates a state-based exchange without the federal platform, the rate shall be set by the commissioner by rule.

AB68-SSA1,1323,9 (5) Rules. The commissioner may promulgate rules necessary to implement this section.

AB68-SSA1,2957 Section 2957. Subchapter VI (title) of chapter 601 [precedes 601.78] of the statutes is created to read:

AB68-SSA1,1323,12 CHAPTER 601

AB68-SSA1,1323,14 SUBCHAPTER VI Prescription drug

AB68-SSA1,1323,15 affordability review board

AB68-SSA1,2958 Section 2958. 601.78 of the statutes is created to read:

AB68-SSA1,1323,17 601.78 Definitions. In this subchapter:

AB68-SSA1,1323,19 (1) “Biologic” means a drug that is produced or distributed in accordance with a biologics license application approved under 21 CFR 601.20.

AB68-SSA1,1323,21 (2) “Biosimilar” means a drug that is produced or distributed in accordance with a biologics license application approved under 42 USC 262 (k) (3).

AB68-SSA1,1323,23 (3) “Board” means the prescription drug affordability review board established under s. 15.735 (1).

AB68-SSA1,1324,3 (4) “Brand name drug” means a drug that is produced or distributed in accordance with an original new drug application approved under 21 USC 355 (c), other than an authorized generic drug, as defined in 42 CFR 447.502.

AB68-SSA1,1324,5 (5) “Drug product” means a brand name drug, a generic drug, a biologic, a biosimilar, or an over-the-counter drug.

AB68-SSA1,1324,9 (6) “Financial benefit” includes an honoraria, fee, stock, the value of the stock holdings of a member of the board or any immediate family member, as defined in s. 97.605 (4) (a) 2., and any direct financial benefit deriving from the finding of a review conducted under s. 601.79.

AB68-SSA1,1324,10 (7) “Generic drug” means any of the following:

AB68-SSA1,1324,12 (a) A retail drug that is marketed or distributed in accordance with an abbreviated new drug application approved under 21 USC 355 (j).

AB68-SSA1,1324,13 (b) An authorized generic drug, as defined in 42 CFR 447.502.

AB68-SSA1,1324,15 (c) A drug that entered the market prior to 1962 and was not originally marketed under a new drug application.

AB68-SSA1,1324,16 (8) “Manufacturer” means an entity that does all of the following:

AB68-SSA1,1324,19 (a) Engages in the manufacture of a drug product or enters into a lease with another manufacturer to market and distribute a prescription drug product under the entity's own name.

AB68-SSA1,1324,21 (b) Sets or changes the wholesale acquisition cost of the drug product or prescription drug product described in par. (a).

AB68-SSA1,1324,23 (9) “Over-the-counter drug” means a drug intended for human use that does not require a prescription and meets the requirements of 21CFR parts 328 to 364.

AB68-SSA1,1324,24 (10) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

AB68-SSA1,1325,2 (11) “Prescription drug product” means a brand name drug, a generic drug, a biologic, or a biosimilar.

AB68-SSA1,2959 Section 2959. 601.785 of the statutes is created to read:

AB68-SSA1,1325,8 601.785 Prescription drug affordability review board. (1) Mission. The purpose of the board is to protect state residents, the state, local governments, health plans, healthcare providers, pharmacies licensed in this state, and other stakeholders of the healthcare system in this state from the high costs of prescription drug products.

AB68-SSA1,1325,9 (2) Powers and duties. (a) The board shall do all of the following:

AB68-SSA1,1325,12 1. Meet in open session at least 4 times per year to review prescription drug product pricing information, except that the chair may cancel or postpone a meeting if there is no business to transact.

AB68-SSA1,1325,14 2. To the extent practicable, access and assess pricing information for prescription drug products by doing all of the following: