This is the preview version of the Wisconsin State Legislature site.
Please see http://docs.legis.wisconsin.gov for the production version.
AB50-ASA2-AA11,25,5205. 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...