AB50-ASA2-AA11,27,431. The number of individuals who received insulin under the manufacturer’s 4urgent need safety net program. AB50-ASA2-AA11,27,752. The number of individuals who sought assistance under the 6manufacturer’s patient assistance program and the number of individuals who 7were determined to be ineligible under sub. (3) (c) 4. AB50-ASA2-AA11,27,983. The wholesale acquisition cost of the insulin provided by the manufacturer 9through the urgent need safety net program and patient assistance program. AB50-ASA2-AA11,27,1310(b) Annually, no later than April 1, the commissioner shall submit to the 11governor and the chief clerk of each house of the legislature, for distribution to the 12legislature under s. 13.172 (2), a report on the urgent need safety net programs and 13patient assistance programs that includes all of the following: AB50-ASA2-AA11,27,14141. The information provided to the commissioner under par. (a). AB50-ASA2-AA11,27,16152. The penalties assessed under sub. (9) during the previous calendar year, 16including the name of the manufacturer and amount of the penalty. AB50-ASA2-AA11,27,2117(8) Additional responsibilities of commissioner. (a) Application form. 18The commissioner shall make the application form described in sub. (2) (c) 1. a. 19available on the office’s website and shall make the form available to pharmacies 20and health care providers who prescribe or dispense insulin, hospital emergency 21departments, urgent care clinics, and community health clinics. AB50-ASA2-AA11,28,222(b) Public outreach. 1. The commissioner shall conduct public outreach to
1create awareness of the urgent need safety net programs and patient assistance 2programs. AB50-ASA2-AA11,28,432. The commissioner shall develop and make available on the office’s website 4an information sheet that contains all of the following information: AB50-ASA2-AA11,28,65a. A description of how to access insulin through an urgent need safety net 6program. AB50-ASA2-AA11,28,87b. A description of how to access insulin through a patient assistance 8program. AB50-ASA2-AA11,28,109c. Information on how to contact a navigator for assistance in accessing 10insulin through an urgent need safety net program or patient assistance program. AB50-ASA2-AA11,28,1211d. Information on how to contact the commissioner if a manufacturer 12determines that an individual is not eligible for a patient assistance program. AB50-ASA2-AA11,28,1413e. A notification that an individual may contact the commissioner for more 14information or assistance in accessing ongoing affordable insulin options. AB50-ASA2-AA11,28,2115(c) Navigators. The commissioner shall develop a training program to provide 16navigators with information and the resources necessary to assist individuals in 17accessing appropriate long-term insulin options. The commissioner shall compile a 18list of navigators that have completed the training program and are available to 19assist individuals in accessing affordable insulin coverage options. The list shall be 20made available on the office’s website and to pharmacies and health care 21practitioners who dispense and prescribe insulin. AB50-ASA2-AA11,29,422(d) Satisfaction surveys. 1. The commissioner shall develop and conduct a 23satisfaction survey of individuals who have accessed insulin through urgent need
1safety net programs and patient assistance programs. The survey shall ask 2whether the individual is still in need of a long-term solution for affordable insulin 3and shall include questions about the individual’s satisfaction with all of the 4following, if applicable: AB50-ASA2-AA11,29,55a. Accessibility to urgent-need insulin. AB50-ASA2-AA11,29,76b. Adequacy of the information sheet and list of navigators received from the 7pharmacy. AB50-ASA2-AA11,29,88c. Helpfulness of a navigator. AB50-ASA2-AA11,29,109d. Ease of access in applying for a patient assistance program and receiving 10insulin from the pharmacy under the patient assistance program. AB50-ASA2-AA11,29,14112. The commissioner shall develop and conduct a satisfaction survey of 12pharmacies that have dispensed insulin through urgent need safety net programs 13and patient assistance programs. The survey shall include questions about the 14pharmacy’s satisfaction with all of the following, if applicable: AB50-ASA2-AA11,29,1615a. Timeliness of reimbursement from manufacturers for insulin dispensed by 16the pharmacy under urgent need safety net programs. AB50-ASA2-AA11,29,1717b. Ease in submitting insulin orders to manufacturers. AB50-ASA2-AA11,29,1818c. Timeliness of receiving insulin orders from manufacturers. AB50-ASA2-AA11,29,20193. The commissioner may contract with a nonprofit entity to develop and 20conduct the surveys under subds. 1. and 2. and to evaluate the survey results. AB50-ASA2-AA11,29,23214. No later than July 1, 2028, the commissioner shall submit to the governor 22and the chief clerk of each house of the legislature, for distribution to the legislature 23under s. 13.172 (2), a report on the results of the surveys under subds. 1. and 2. AB50-ASA2-AA11,30,5
1(9) Penalty. A manufacturer that violates this section may be required to 2forfeit not more than $200,000 per month of violation, with the maximum forfeiture 3increasing to $400,000 per month if the manufacturer continues to be in violation 4after 6 months and increasing to $600,000 per month if the manufacturer continues 5to be in violation after one year. AB50-ASA2-AA11,116Section 11. 632.895 (6) (title) of the statutes is amended to read: AB50-ASA2-AA11,30,87632.895 (6) (title) Equipment and supplies for treatment of diabetes; 8insulin. AB50-ASA2-AA11,129Section 12. 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and 10amended to read: AB50-ASA2-AA11,30,2111632.895 (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-AA11,30,2323632.895 (6) (b) 1. In this paragraph: AB50-ASA2-AA11,31,3
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-AA11,31,44b. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c). AB50-ASA2-AA11,31,752. 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-AA11,31,1183. 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-AA11,31,1913(1) Staggered terms for prescription drug affordability review board. 14Notwithstanding the length of terms specified for the members of the prescription 15drug affordability review board under s. 15.735 (1) (b) to (e), 2 of the initial 16members shall be appointed for terms expiring on May 1, 2027; 2 of the initial 17members shall be appointed for terms expiring on May 1, 2028; 2 of the initial 18members shall be appointed for terms expiring on May 1, 2029; and 2 of the initial 19members shall be appointed for terms expiring on May 1, 2030. AB50-ASA2-AA11,32,320(2) Prescription drug importation program. The commissioner of 21insurance shall submit the first report required under s. 601.575 (5) by the next 22January 1 or July 1, whichever is earliest, that is at least 180 days after the date the 23prescription drug importation program is fully operational under s. 601.575 (4).
1The commissioner of insurance shall include in the first 3 reports submitted under 2s. 601.575 (5) information on the implementation of the audit functions under s. 3601.575 (1) (n). AB50-ASA2-AA11,32,64(3) Prescription drug purchasing entity. During the 2025-27 fiscal 5biennium, the office of the commissioner of insurance shall conduct a study on the 6viability of creating or implementing a state prescription drug purchasing entity. AB50-ASA2-AA11,32,198(1) Office of prescription drug affordability. In the schedule under s. 920.005 (3) for the appropriation to the office of the commissioner of insurance under 10s. 20.145 (1) (g), the dollar amount for fiscal year 2025-26 is increased by $1,957,300 11to provide $500,000 in onetime implementation costs for establishing an office of 12prescription drug affordability in the office of the commissioner of insurance and 13$1,457,300 to authorize 16.0 PR positions within the office of prescription drug 14affordability, including 5.0 insurance examiners, 4.0 policy initiatives advisors, 2.0 15attorneys, 1.0 insurance program manager, 2.0 insurance administrators, and 2.0 16operations program associates. In the schedule under s. 20.005 (3) for the 17appropriation to the office of the commissioner of insurance under s. 20.145 (1) (g), 18the dollar amount for fiscal year 2026-27 is increased by $1,871,100 to fund the 19positions authorized under this subsection. AB50-ASA2-AA11,32,2421(1) Prescription drug affordability review board. The treatment of ss. 2215.07 (3) (bm) 7., 15.735, 601.78, 601.785, and 601.79 and subch. VI (title) of ch. 601 23and Section 9123 (1) of this act take effect on the first day of the 7th month 24beginning after publication. AB50-ASA2-AA11,33,4
1(2) Cost-sharing cap on insulin. The treatment of ss. 609.83 and 632.895 2(6) (title), the renumbering and amendment of s. 632.895 (6), and the creation of s. 3632.895 (6) (b) take effect on the first day of the 4th month beginning after 4publication.”.
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