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AB50-ASA2-AA11,13,1714(b) A brand name drug or biologic that, as adjusted annually to reflect
15adjustments to the U.S. consumer price index for all urban consumers, U.S. city
16average, as determined by the U.S. department of labor, has a wholesale acquisition
17cost that has increased by at least $3,000 during a 12-month period.
AB50-ASA2-AA11,13,2018(c) A biosimilar that has a launch wholesale acquisition cost that is not at
19least 15 percent lower than the referenced brand biologic at the time the biosimilar
20is launched.
AB50-ASA2-AA11,14,221(d) A generic drug that has a wholesale acquisition cost, as adjusted annually
22to reflect adjustments to the U.S. consumer price index for all urban consumers,

1U.S. city average, as determined by the U.S. department of labor, that meets all of
2the following conditions:
AB50-ASA2-AA11,14,831. Is at least $100 for a supply lasting a patient for a period of 30 consecutive
4days based on the recommended dosage approved for labeling by the federal food
5and drug administration, a supply lasting a patient for a period of fewer than 30
6days based on the recommended dosage approved for labeling by the federal food
7and drug administration, or one unit of the drug if the labeling approved by the
8federal food and drug administration does not recommend a finite dosage.
AB50-ASA2-AA11,14,1292. Increased by at least 200 percent during the preceding 12-month period, as
10determined by the difference between the resulting wholesale acquisition cost and
11the average of the wholesale acquisition cost reported over the preceding 12
12months.
AB50-ASA2-AA11,14,1513(e) Other prescription drug products, including drugs to address public health
14emergencies, that may create affordability challenges for the health care system
15and patients in this state.
AB50-ASA2-AA11,14,2016(2) Affordability review. (a) After identifying prescription drug products
17under sub. (1), the board shall determine whether to conduct an affordability
18review for each identified prescription drug product by seeking stakeholder input
19about the prescription drug product and considering the average patient cost share
20of the prescription drug product.
AB50-ASA2-AA11,15,321(b) The information used to conduct an affordability review under par. (a) may
22include any document and research related to the manufacturers selection of the
23introductory price or price increase of the prescription drug product, including life

1cycle management, net average price in this state, market competition and context,
2projected revenue, and the estimated value or cost-effectiveness of the prescription
3drug product.
AB50-ASA2-AA11,15,64(c) The failure of a manufacturer to provide the board with information for an
5affordability review under par. (b) does not affect the authority of the board to
6conduct the review.
AB50-ASA2-AA11,15,147(3) Affordability challenge. When conducting an affordability review of a
8prescription drug product under sub. (2), the board shall determine whether use of
9the prescription drug product that is fully consistent with the labeling approved by
10the federal food and drug administration or standard medical practice has led or
11will lead to an affordability challenge for the health care system in this state,
12including high out-of-pocket costs for patients. To the extent practicable, in
13determining whether a prescription drug product has led or will lead to an
14affordability challenge, the board shall consider all of the following factors:
AB50-ASA2-AA11,15,1615(a) The wholesale acquisition cost for the prescription drug product sold in
16this state.
AB50-ASA2-AA11,15,2017(b) The average monetary price concession, discount, or rebate the
18manufacturer provides, or is expected to provide, to health plans in this state as
19reported by manufacturers and health plans, expressed as a percentage of the
20wholesale acquisition cost for the prescription drug product under review.
AB50-ASA2-AA11,16,221(c) The total amount of the price concessions, discounts, and rebates the
22manufacturer provides to each pharmacy benefit manager for the prescription drug

1product under review, as reported by the manufacturer and pharmacy benefit
2manager and expressed as a percentage of the wholesale acquisition cost.
AB50-ASA2-AA11,16,43(d) The price at which therapeutic alternatives to the prescription drug
4product have been sold in this state.
AB50-ASA2-AA11,16,75(e) The average monetary concession, discount, or rebate the manufacturer
6provides or is expected to provide to health plan payors and pharmacy benefit
7managers in this state for therapeutic alternatives to the prescription drug product.
AB50-ASA2-AA11,16,108(f) The costs to health plans based on patient access consistent with labeled
9indications by the federal food and drug administration and recognized standard
10medical practice.
AB50-ASA2-AA11,16,1211(g) The impact on patient access resulting from the cost of the prescription
12drug product relative to insurance benefit design.
AB50-ASA2-AA11,16,1413(h) The current or expected dollar value of drug-specific patient access
14programs that are supported by the manufacturer.
AB50-ASA2-AA11,16,1715(i) The relative financial impacts to health, medical, or social services costs
16that can be quantified and compared to baseline effects of existing therapeutic
17alternatives to the prescription drug product.
AB50-ASA2-AA11,16,1918(j) The average patient copay or other cost sharing for the prescription drug
19product in this state.
AB50-ASA2-AA11,16,2020(k) Any information a manufacturer chooses to provide.
AB50-ASA2-AA11,16,2121(L) Any other factors as determined by the board by rule.
AB50-ASA2-AA11,17,222(4) Upper payment limit. (a) If the board determines under sub. (3) that use
23of a prescription drug product has led or will lead to an affordability challenge, the

1board shall establish an upper payment limit for the prescription drug product after
2considering all of the following:
AB50-ASA2-AA11,17,331. The cost of administering the drug.
AB50-ASA2-AA11,17,442. The cost of delivering the drug to consumers.
AB50-ASA2-AA11,17,553. Other relevant administrative costs related to the drug.
AB50-ASA2-AA11,17,116(b) For a prescription drug product identified in sub. (1) (b) or (d) 2., the board
7shall solicit information from the manufacturer regarding the price increase. To
8the extent that the price increase is not a result of the need for increased
9manufacturing capacity or other effort to improve patient access during a public
10health emergency, the board shall establish an upper payment limit under par. (a)
11that is equal to the cost to consumers prior to the price increase.
AB50-ASA2-AA11,17,1512(c) 1. The upper payment limit established under this subsection shall apply
13to all purchases and payor reimbursements of the prescription drug product
14dispensed or administered to individuals in this state in person, by mail, or by other
15means.
AB50-ASA2-AA11,18,3162. Notwithstanding subd. 1., while state-sponsored and state-regulated
17health plans and health programs shall limit drug reimbursements and drug
18payment to no more than the upper payment limit established under this
19subsection, a plan subject to the Employee Retirement Income Security Act of 1974
20or Part D of Medicare under 42 USC 1395w-101 et seq. may choose to reimburse
21more than the upper payment limit. A provider who dispenses and administers a
22prescription drug product in this state to an individual in this state may not bill a
23payor more than the upper payment limit to the patient regardless of whether a

1plan subject to the Employee Retirement Income Security Act of 1974 or Part D of
2Medicare under 42 USC 1395w-101 et seq. chooses to reimburse the provider above
3the upper payment limit.
AB50-ASA2-AA11,18,54(5) Public inspection. Information submitted to the board under this
5section shall be open to public inspection only as provided under ss. 19.31 to 19.39.
AB50-ASA2-AA11,18,96(6) No prohibition on marketing. Nothing in this section may be construed
7to prevent a manufacturer from marketing a prescription drug product approved by
8the federal food and drug administration while the prescription drug product is
9under review by the board.
AB50-ASA2-AA11,18,1410(7) Appeals. A person aggrieved by a decision of the board may request an
11appeal of the decision no later than 30 days after the board makes the
12determination. The board shall hear the appeal and make a final decision no later
13than 60 days after the appeal is requested. A person aggrieved by a final decision of
14the board may petition for judicial review in a court of competent jurisdiction.
AB50-ASA2-AA11,915Section 9. 609.83 of the statutes is amended to read:
AB50-ASA2-AA11,18,1816609.83 Coverage of drugs and devices. Limited service health
17organizations, preferred provider plans, and defined network plans are subject to
18ss. 632.853, 632.861, and 632.895 (6) (b), (16t), and (16v).
AB50-ASA2-AA11,1019Section 10. 632.868 of the statutes is created to read:
AB50-ASA2-AA11,18,2020632.868 Insulin safety net programs. (1) Definitions. In this section:
AB50-ASA2-AA11,18,2221(a) Manufacturer means a person engaged in the manufacturing of insulin
22that is self-administered on an outpatient basis.
AB50-ASA2-AA11,18,2323(b) Navigator has the meaning given in s. 628.90 (3).
AB50-ASA2-AA11,19,2
1(c) Patient assistance program means a program established by a
2manufacturer under sub. (3) (a).
AB50-ASA2-AA11,19,33(d) Pharmacy means an entity licensed under s. 450.06 or 450.065.
AB50-ASA2-AA11,19,64(e) Urgent need of insulin means having less than a 7-day supply of insulin
5readily available for use and needing insulin in order to avoid the likelihood of
6suffering a significant health consequence.
AB50-ASA2-AA11,19,87(f) Urgent need safety net program means a program established by a
8manufacturer under sub. (2) (a).
AB50-ASA2-AA11,19,129(2) Urgent need safety net program. (a) Establishment of program. No
10later than July 1, 2026, each manufacturer shall establish an urgent need safety net
11program to make insulin available in accordance with this subsection to individuals
12who meet the eligibility requirements under par. (b).
AB50-ASA2-AA11,19,1413(b) Eligible individual. An individual shall be eligible to receive insulin under
14an urgent need safety net program if all of the following conditions are met:
AB50-ASA2-AA11,19,15151. The individual is in urgent need of insulin.
AB50-ASA2-AA11,19,16162. The individual is a resident of this state.
AB50-ASA2-AA11,19,17173. The individual is not receiving public assistance under ch. 49.
AB50-ASA2-AA11,19,22184. The individual is not enrolled in prescription drug coverage through an
19individual or group health plan that limits the total cost sharing amount, including
20copayments, deductibles, and coinsurance, that an enrollee is required to pay for a
2130-day supply of insulin to no more than $75, regardless of the type or amount of
22insulin prescribed.
AB50-ASA2-AA11,20,2
15. The individual has not received insulin under an urgent need safety net
2program within the previous 12 months, except as allowed under par. (d).
AB50-ASA2-AA11,20,63(c) Provision of insulin under an urgent need safety net program. 1. In order
4to receive insulin under an urgent need safety net program, an individual who
5meets the eligibility requirements under par. (b) shall provide a pharmacy with all
6of the following:
AB50-ASA2-AA11,20,107a. A completed application, on a form prescribed by the commissioner that
8shall include an attestation by the individual, or the individuals parent or legal
9guardian if the individual is under the age of 18, that the individual meets all of the
10eligibility requirements under par. (b).
AB50-ASA2-AA11,20,1111b. A valid insulin prescription.
AB50-ASA2-AA11,20,1412c. A valid Wisconsin drivers license or state identification card. If the
13individual is under the age of 18, the individuals parent or legal guardian shall
14meet this requirement.
AB50-ASA2-AA11,20,22152. Upon receipt of the information described in subd. 1. a. to c., the pharmacist
16shall dispense a 30-day supply of the prescribed insulin to the individual. The
17pharmacy shall also provide the individual with the information sheet described in
18sub. (8) (b) 2. and the list of navigators described in sub. (8) (c). The pharmacy may
19collect a copayment, not to exceed $35, from the individual to cover the pharmacys
20costs of processing and dispensing the insulin. The pharmacy shall notify the
21health care practitioner who issued the prescription no later than 72 hours after the
22insulin is dispensed.
AB50-ASA2-AA11,21,7233. A pharmacy that dispenses insulin under subd. 2. may submit to the

1manufacturer, or the manufacturers vendor, a claim for payment that is in
2accordance with the national council for prescription drug programs standards for
3electronic claims processing, except that no claim may be submitted if the
4manufacturer agrees to send the pharmacy a replacement of the same insulin in
5the amount dispensed. If the pharmacy submits an electronic claim, the
6manufacturer or vendor shall reimburse the pharmacy in an amount that covers
7the pharmacys acquisition cost.
AB50-ASA2-AA11,21,984. A pharmacy that dispenses insulin under subd. 2. shall retain a copy of the
9application form described in subd. 1. a.
AB50-ASA2-AA11,21,1610(d) Eligibility of certain individuals. An individual who has applied for public
11assistance under ch. 49 but for whom a determination of eligibility has not been
12made or whose coverage has not become effective or an individual who has an
13appeal pending under sub. (3) (c) 4. may access insulin under this subsection if the
14individual is in urgent need of insulin. To access a 30-day supply of insulin, the
15individual shall attest to the pharmacy that the individual is described in this
16paragraph and comply with par. (c) 1.
AB50-ASA2-AA11,21,2117(3) Patient assistance program. (a) Establishment of program. No later
18than July 1, 2026, each manufacturer shall establish a patient assistance program
19to make insulin available in accordance with this subsection to individuals who
20meet the eligibility requirements under par. (b). Under the patient assistance
21program, the manufacturer shall do all of the following:
AB50-ASA2-AA11,22,2221. Provide the commissioner with information regarding the patient

1assistance program, including contact information for individuals to call for
2assistance in accessing the patient assistance program.
AB50-ASA2-AA11,22,432. Provide a hotline for individuals to call or access between 8 a.m. and 10 p.m.
4on weekdays and between 10 a.m. and 6 p.m. on Saturdays.
AB50-ASA2-AA11,22,653. List the eligibility requirements under par. (b) on the manufacturers
6website.
AB50-ASA2-AA11,22,1074. Maintain the privacy of all information received from an individual
8applying for or participating in the patient assistance program and not sell, share,
9or disseminate the information unless required under this section or authorized, in
10writing, by the individual.
AB50-ASA2-AA11,22,1211(b) Eligible individual. An individual shall be eligible to receive insulin under
12a patient assistance program if all of the following conditions are met:
AB50-ASA2-AA11,22,13131. The individual is a resident of this state.
AB50-ASA2-AA11,22,16142. The individual, or the individuals parent or legal guardian if the individual
15is under the age of 18, has a valid Wisconsin drivers license or state identification
16card.
AB50-ASA2-AA11,22,17173. The individual has a valid insulin prescription.
AB50-ASA2-AA11,22,20184. The family income of the individual does not exceed 400 percent of the
19poverty line as defined and revised annually under 42 USC 9902 (2) for a family the
20size of the individuals family.
AB50-ASA2-AA11,22,21215. The individual is not receiving public assistance under ch. 49.
AB50-ASA2-AA11,23,4226. The individual is not eligible to receive health care through a federally
23funded program or receive prescription drug benefits through the U.S. department

1of veterans affairs, except that this subdivision does not apply to an individual who
2is enrolled in a policy under Part D of Medicare under 42 USC 1395w-101 et seq. if
3the individual has spent at least $1,000 on prescription drugs in the current
4calendar year.
AB50-ASA2-AA11,23,957. The individual is not enrolled in prescription drug coverage through an
6individual or group health plan that limits the total cost sharing amount, including
7copayments, deductibles, and coinsurance, that an enrollee is required to pay for a
830-day supply of insulin to no more than $75, regardless of the type or amount of
9insulin needed.
AB50-ASA2-AA11,23,1910(c) Application for patient assistance program. 1. An individual may apply to
11participate in a patient assistance program by filing an application with the
12manufacturer that established the patient assistance program, the individuals
13health care practitioner if the practitioner participates in the patient assistance
14program, or a navigator included on the list under sub. (8) (c). A health care
15practitioner or navigator shall immediately submit the application to the
16manufacturer. Upon receipt of an application, the manufacturer shall determine
17the individuals eligibility under par. (b) and, except as provided in subd. 2., notify
18the individual of the determination no later than 10 days after receipt of the
19application.
AB50-ASA2-AA11,24,2202. If necessary to determine the individuals eligibility under par. (b), the
21manufacturer may request additional information from an individual who has filed
22an application under subd. 1. no later than 5 days after receipt of the application.
23Upon receipt of the additional information, the manufacturer shall determine the

1individuals eligibility under par. (b) and notify the individual of the determination
2no later than 3 days after receipt of the requested information.
AB50-ASA2-AA11,24,833. Except as provided in subd. 5., if the manufacturer determines under subd.
41. or 2. that the individual is eligible for the patient assistance program, the
5manufacturer shall provide the individual with a statement of eligibility. The
6statement of eligibility shall be valid for 12 months and may be renewed upon a
7determination by the manufacturer that the individual continues to meet the
8eligibility requirements under par. (b).
AB50-ASA2-AA11,24,1994. If the manufacturer determines under subd. 1. or 2. that the individual is
10not eligible for the patient assistance program, the manufacturer shall provide the
11reason for the determination in the notification under subd. 1. or 2. The individual
12may appeal the determination by filing an appeal with the commissioner that shall
13include all of the information provided to the manufacturer under subds. 1. and 2.
14The commissioner shall establish procedures for deciding appeals under this
15subdivision. The commissioner shall issue a decision no later than 10 days after the
16appeal is filed, and the commissioners decision shall be final. If the commissioner
17determines that the individual meets the eligibility requirements under par. (b), the
18manufacturer shall provide the individual with the statement of eligibility
19described in subd. 3.
AB50-ASA2-AA11,25,5205. In the case of an individual who has prescription drug coverage through an
21individual or group health plan, if the manufacturer determines under subd. 1. or 2.
22that the individual is eligible for the patient assistance program but also
23determines that the individuals insulin needs are better addressed through the use

1of the manufacturers copayment assistance program rather than the patient
2assistance program, the manufacturer shall inform the individual of the
3determination and provide the individual with the necessary coupons to submit to
4a pharmacy. The individual may not be required to pay more than the copayment
5amount specified in par. (d) 2.
AB50-ASA2-AA11,25,126(d) Provision of insulin under a patient assistance program. 1. Upon receipt
7from an individual of the eligibility statement described in par. (c) 3. and a valid
8insulin prescription, a pharmacy shall submit an order containing the name of the
9insulin and daily dosage amount to the manufacturer. The pharmacy shall include
10with the order the pharmacys name, shipping address, office telephone number,
11fax number, email address, and contact name, as well as any days or times when
12deliveries are not accepted by the pharmacy.
AB50-ASA2-AA11,25,21132. Upon receipt of an order meeting the requirements under subd. 1., the
14manufacturer shall send the pharmacy a 90-day supply of insulin, or lesser amount
15if requested in the order, at no charge to the individual or pharmacy. The pharmacy
16shall dispense the insulin to the individual associated with the order. The insulin
17shall be dispensed at no charge to the individual, except that the pharmacy may
18collect a copayment from the individual to cover the pharmacys costs for processing
19and dispensing in an amount not to exceed $50 for each 90-day supply of insulin.
20The pharmacy may not seek reimbursement from the manufacturer or a 3rd-party
21payer.
AB50-ASA2-AA11,26,2223. The pharmacy may submit a reorder to the manufacturer if the individuals

1eligibility statement described in par. (c) 3. has not expired. The reorder shall be
2treated as an order for purposes of subd. 2.
AB50-ASA2-AA11,26,534. Notwithstanding subds. 2. and 3., a manufacturer may send the insulin
4directly to the individual if the manufacturer provides a mail-order service option,
5in which case the pharmacy may not collect a copayment from the individual.
AB50-ASA2-AA11,26,86(4) Exceptions. (a) This section does not apply to a manufacturer that shows
7to the commissioners satisfaction that the manufacturers annual gross revenue
8from insulin sales in this state does not exceed $2,000,000.
AB50-ASA2-AA11,26,139(b) A manufacturer may not be required to make an insulin product available
10under sub. (2) or (3) if the wholesale acquisition cost of the insulin product does not
11exceed $8, as adjusted annually based on the U.S. consumer price index for all
12urban consumers, U.S. city average, per milliliter or the applicable national council
13for prescription drug programs plan billing unit.
AB50-ASA2-AA11,26,1614(5) Confidentiality. All medical information solicited or obtained by any
15person under this section shall be subject to the applicable provisions of state law
16relating to confidentiality of medical information, including s. 610.70.
AB50-ASA2-AA11,26,2217(6) Reimbursement prohibition. No person, including a manufacturer,
18pharmacy, pharmacist, or 3rd-party administrator, as part of participating in an
19urgent need safety net program or patient assistance program may request or seek,
20or cause another person to request or seek, any reimbursement or other
21compensation for which payment may be made in whole or in part under a federal
22health care program, as defined in 42 USC 1320a-7b (f).
AB50-ASA2-AA11,27,223(7) Reports. (a) Annually, no later than March 1, each manufacturer shall

1report to the commissioner all of the following information for the previous calendar
2year:
AB50-ASA2-AA11,27,431. The number of individuals who received insulin under the manufacturers
4urgent need safety net program.
AB50-ASA2-AA11,27,752. The number of individuals who sought assistance under the
6manufacturers 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).
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