This is the preview version of the Wisconsin State Legislature site.
Please see http://docs.legis.wisconsin.gov for the production version.
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).
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 offices 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 offices 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 offices 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 individuals 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
14pharmacys 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-AA11,1322Section 13. 632.895 (6) (b) of the statutes is created to read:
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-AA11,912312Section 9123. Nonstatutory provisions; Insurance.
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-AA11,92237Section 9223. Fiscal changes; Insurance.
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-AA11,942320Section 9423. Effective dates; Insurance.
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..
Loading...
Loading...