AB50-ASA2-AA16,10,161571.54 (2) (b) 5. Subject to sub. (2m), in calendar year 2025 or any subsequent 16calendar year, $1,460. AB50-ASA2-AA16,11,121871.54 (2m) Indexing for inflation; 2010 2026 and thereafter. (a) For 19calendar years beginning after December 31, 2009, and before January 1, 2011 202025, the dollar amounts of the threshold income under sub. (1) (f) (h) 1. and 2., the 21maximum household income under sub. (1) (f) (h) 3., and the maximum property 22taxes under sub. (2) (b) 3. 5. shall be increased each year by a percentage equal to 23the percentage change between the U.S. consumer price index for all urban
1consumers, U.S. city average, for the 12-month average of the U.S. consumer price 2index for the month of August of the year before the previous year through the 3month of July of the previous year and the U.S. consumer price index for all urban 4consumers, U.S. city average, for the 12-month average of the U.S. consumer price 5index for August 2007 through July 2008 2024, as determined by the federal 6department of labor, except that the adjustment may occur only if the percentage is 7a positive number. Each amount that is revised under this paragraph shall be 8rounded to the nearest multiple of $10 if the revised amount is not a multiple of $10 9or, if the revised amount is a multiple of $5, such an amount shall be increased to 10the next higher multiple of $10. The department of revenue shall annually adjust 11the changes in dollar amounts required under this paragraph and incorporate the 12changes into the income tax forms and instructions. AB50-ASA2-AA16,11,1813(b) The department of revenue shall annually adjust the slope under sub. (1) 14(f) (h) 2. such so that, as a claimant’s income increases from the threshold income as 15calculated adjusted under par. (a), to an amount that exceeds the maximum 16household income as calculated adjusted under par. (a), the credit that may be 17claimed is reduced to $0, and the department of revenue shall incorporate the 18changes into the income tax forms and instructions. AB50-ASA2-AA16,11,2120(1) Homestead tax credit. The treatment of s. 71.54 (1) (h) first applies to 21claims filed for taxable years beginning after December 31, 2024.”. AB50-ASA2-AA16,12,3
1(1) Prescription drug purchasing entity. During the 2025-27 fiscal 2biennium, the office of the commissioner of insurance shall conduct a study on the 3viability of creating or implementing a state prescription drug purchasing entity.”. AB50-ASA2-AA16,12,116601.41 (14) Value-based diabetes medication pilot project. The 7commissioner shall develop a pilot project to direct a pharmacy benefit manager, as 8defined in s. 632.865 (1) (c), and a pharmaceutical manufacturer to create a value-9based, sole-source arrangement to reduce the costs of prescription medication used 10to treat diabetes. The commissioner may promulgate rules to implement this 11subsection.”. AB50-ASA2-AA16,12,1414632.868 Insulin safety net programs. (1) Definitions. In this section: AB50-ASA2-AA16,12,1615(a) “Manufacturer” means a person engaged in the manufacturing of insulin 16that is self-administered on an outpatient basis. AB50-ASA2-AA16,12,1717(b) “Navigator” has the meaning given in s. 628.90 (3). AB50-ASA2-AA16,12,1918(c) “Patient assistance program” means a program established by a 19manufacturer under sub. (3) (a). AB50-ASA2-AA16,12,2020(d) “Pharmacy” means an entity licensed under s. 450.06 or 450.065. AB50-ASA2-AA16,12,2321(e) “Urgent need of insulin” means having less than a 7-day supply of insulin 22readily available for use and needing insulin in order to avoid the likelihood of 23suffering a significant health consequence. AB50-ASA2-AA16,13,2
1(f) “Urgent need safety net program” means a program established by a 2manufacturer under sub. (2) (a). AB50-ASA2-AA16,13,63(2) Urgent need safety net program. (a) Establishment of program. No 4later than July 1, 2026, each manufacturer shall establish an urgent need safety net 5program to make insulin available in accordance with this subsection to individuals 6who meet the eligibility requirements under par. (b). AB50-ASA2-AA16,13,87(b) Eligible individual. An individual is eligible to receive insulin under an 8urgent need safety net program if all of the following conditions are met: AB50-ASA2-AA16,13,991. The individual is in urgent need of insulin. AB50-ASA2-AA16,13,10102. The individual is a resident of this state. AB50-ASA2-AA16,13,11113. The individual is not receiving public assistance under ch. 49. AB50-ASA2-AA16,13,16124. The individual is not enrolled in prescription drug coverage through an 13individual or group health plan that limits the total cost sharing amount, including 14copayments, deductibles, and coinsurance, that an enrollee is required to pay for a 1530-day supply of insulin to no more than $75, regardless of the type or amount of 16insulin prescribed. AB50-ASA2-AA16,13,18175. The individual has not received insulin under an urgent need safety net 18program within the previous 12 months, except as allowed under par. (d). AB50-ASA2-AA16,13,2219(c) Provision of insulin under an urgent need safety net program. 1. In order 20to receive insulin under an urgent need safety net program, an individual who 21meets the eligibility requirements under par. (b) shall provide a pharmacy with all 22of the following: AB50-ASA2-AA16,14,323a. A completed application, on a form prescribed by the commissioner that
1includes an attestation by the individual, or the individual’s parent or legal 2guardian if the individual is under the age of 18, that the individual meets all of the 3eligibility requirements under par. (b). AB50-ASA2-AA16,14,44b. A valid insulin prescription. AB50-ASA2-AA16,14,75c. A valid Wisconsin driver’s license or state identification card. If the 6individual is under the age of 18, the individual’s parent or legal guardian shall 7meet this requirement. AB50-ASA2-AA16,14,1582. Upon receipt of the information described in subd. 1. a. to c., the pharmacist 9shall dispense a 30-day supply of the prescribed insulin to the individual. The 10pharmacy shall also provide the individual with the information sheet described in 11sub. (8) (b) 2. and the list of navigators described in sub. (8) (c). The pharmacy may 12collect a copayment, not to exceed $35, from the individual to cover the pharmacy’s 13costs of processing and dispensing the insulin. The pharmacy shall notify the 14health care practitioner who issued the prescription no later than 72 hours after the 15insulin is dispensed. AB50-ASA2-AA16,14,23163. A pharmacy that dispenses insulin under subd. 2. may submit to the 17manufacturer, or the manufacturer’s vendor, a claim for payment that is in 18accordance with the national council for prescription drug programs’ standards for 19electronic claims processing, except that no claim may be submitted if the 20manufacturer agrees to send the pharmacy a replacement of the same insulin in 21the amount dispensed. If the pharmacy submits an electronic claim, the 22manufacturer or vendor shall reimburse the pharmacy in an amount that covers 23the pharmacy’s acquisition cost. AB50-ASA2-AA16,15,2
14. A pharmacy that dispenses insulin under subd. 2. shall retain a copy of the 2application form described in subd. 1. a. AB50-ASA2-AA16,15,93(d) Eligibility of certain individuals. An individual who has applied for public 4assistance under ch. 49 but for whom a determination of eligibility has not been 5made or whose coverage has not become effective or an individual who has an 6appeal pending under sub. (3) (c) 4. may access insulin under this subsection if the 7individual is in urgent need of insulin. To access a 30-day supply of insulin, the 8individual shall attest to the pharmacy that the individual is described in this 9paragraph and comply with par. (c) 1. AB50-ASA2-AA16,15,1410(3) Patient assistance program. (a) Establishment of program. No later 11than July 1, 2026, each manufacturer shall establish a patient assistance program 12to make insulin available in accordance with this subsection to individuals who 13meet the eligibility requirements under par. (b). Under the patient assistance 14program, the manufacturer shall do all of the following: AB50-ASA2-AA16,15,17151. Provide the commissioner with information regarding the patient 16assistance program, including contact information for individuals to call for 17assistance in accessing the patient assistance program. AB50-ASA2-AA16,15,19182. Provide a hotline for individuals to call or access between 8 a.m. and 10 p.m. 19on weekdays and between 10 a.m. and 6 p.m. on Saturdays. AB50-ASA2-AA16,15,21203. List the eligibility requirements under par. (b) on the manufacturer’s 21website. AB50-ASA2-AA16,16,2224. Maintain the privacy of all information received from an individual 23applying for or participating in the patient assistance program and not sell, share,
1or disseminate the information unless required under this section or authorized, in 2writing, by the individual. AB50-ASA2-AA16,16,43(b) Eligible individual. An individual shall be eligible to receive insulin under 4a patient assistance program if all of the following conditions are met: AB50-ASA2-AA16,16,551. The individual is a resident of this state. AB50-ASA2-AA16,16,862. The individual, or the individual’s parent or legal guardian if the individual 7is under the age of 18, has a valid Wisconsin driver’s license or state identification 8card. AB50-ASA2-AA16,16,993. The individual has a valid insulin prescription. AB50-ASA2-AA16,16,12104. The family income of the individual does not exceed 400 percent of the 11poverty line as defined and revised annually under 42 USC 9902 (2) for a family the 12size of the individual’s family. AB50-ASA2-AA16,16,13135. The individual is not receiving public assistance under ch. 49. AB50-ASA2-AA16,16,19146. The individual is not eligible to receive health care through a federally 15funded program or receive prescription drug benefits through the U.S. department 16of veterans affairs, except that this subdivision does not apply to an individual who 17is enrolled in a policy under Part D of Medicare under 42 USC 1395w-101 et seq. if 18the individual has spent at least $1,000 on prescription drugs in the current 19calendar year. AB50-ASA2-AA16,17,2207. The individual is not enrolled in prescription drug coverage through an 21individual or group health plan that limits the total cost sharing amount, including 22copayments, deductibles, and coinsurance, that an enrollee is required to pay for a
130-day supply of insulin to no more than $75, regardless of the type or amount of 2insulin needed. AB50-ASA2-AA16,17,123(c) Application for patient assistance program. 1. An individual may apply to 4participate in a patient assistance program by filing an application with the 5manufacturer that established the patient assistance program, the individual’s 6health care practitioner if the practitioner participates in the patient assistance 7program, or a navigator included on the list under sub. (8) (c). A health care 8practitioner or navigator shall immediately submit the application to the 9manufacturer. Upon receipt of an application, the manufacturer shall determine 10the individual’s eligibility under par. (b) and, except as provided in subd. 2., notify 11the individual of the determination no later than 10 days after receipt of the 12application. AB50-ASA2-AA16,17,18132. If necessary to determine the individual’s eligibility under par. (b), the 14manufacturer may request additional information from an individual who has filed 15an application under subd. 1. no later than 5 days after receipt of the application. 16Upon receipt of the additional information, the manufacturer shall determine the 17individual’s eligibility under par. (b) and notify the individual of the determination 18no later than 3 days after receipt of the requested information. AB50-ASA2-AA16,18,2193. Except as provided in subd. 5., if the manufacturer determines under subd. 201. or 2. that the individual is eligible for the patient assistance program, the 21manufacturer shall provide the individual with a statement of eligibility. The 22statement of eligibility shall be valid for 12 months and may be renewed upon a
1determination by the manufacturer that the individual continues to meet the 2eligibility requirements under par. (b). AB50-ASA2-AA16,18,1334. If the manufacturer determines under subd. 1. or 2. that the individual is 4not eligible for the patient assistance program, the manufacturer shall provide the 5reason for the determination in the notification under subd. 1. or 2. The individual 6may appeal the determination by filing an appeal with the commissioner that shall 7include all of the information provided to the manufacturer under subds. 1. and 2. 8The commissioner shall establish procedures for deciding appeals under this 9subdivision. The commissioner shall issue a decision no later than 10 days after the 10appeal is filed, and the commissioner’s decision shall be final. If the commissioner 11determines that the individual meets the eligibility requirements under par. (b), the 12manufacturer shall provide the individual with the statement of eligibility 13described in subd. 3. AB50-ASA2-AA16,18,22145. In the case of an individual who has prescription drug coverage through an 15individual or group health plan, if the manufacturer determines under subd. 1. or 2. 16that the individual is eligible for the patient assistance program but also 17determines that the individual’s insulin needs are better addressed through the use 18of the manufacturer’s copayment assistance program rather than the patient 19assistance program, the manufacturer shall inform the individual of the 20determination and provide the individual with the necessary coupons to submit to 21a pharmacy. The individual may not be required to pay more than the copayment 22amount specified in par. (d) 2. AB50-ASA2-AA16,19,623(d) Provision of insulin under a patient assistance program. 1. Upon receipt
1from an individual of the eligibility statement described in par. (c) 3. and a valid 2insulin prescription, a pharmacy shall submit an order containing the name of the 3insulin and daily dosage amount to the manufacturer. The pharmacy shall include 4with the order the pharmacy’s name, shipping address, office telephone number, 5fax number, email address, and contact name, as well as any days or times when 6deliveries are not accepted by the pharmacy. AB50-ASA2-AA16,19,1572. Upon receipt of an order meeting the requirements under subd. 1., the 8manufacturer shall send the pharmacy a 90-day supply of insulin, or lesser amount 9if requested in the order, at no charge to the individual or pharmacy. The pharmacy 10shall dispense the insulin to the individual associated with the order. The insulin 11shall be dispensed at no charge to the individual, except that the pharmacy may 12collect a copayment from the individual to cover the pharmacy’s costs for processing 13and dispensing in an amount not to exceed $50 for each 90-day supply of insulin. 14The pharmacy may not seek reimbursement from the manufacturer or a 3rd-party 15payer. AB50-ASA2-AA16,19,18163. The pharmacy may submit a reorder to the manufacturer if the individual’s 17eligibility statement described in par. (c) 3. has not expired. The reorder shall be 18treated as an order for purposes of subd. 2. AB50-ASA2-AA16,19,21194. Notwithstanding subds. 2. and 3., a manufacturer may send the insulin 20directly to the individual if the manufacturer provides a mail-order service option, 21in which case the pharmacy may not collect a copayment from the individual. AB50-ASA2-AA16,20,222(4) Exceptions. (a) This section does not apply to a manufacturer that shows
1to the commissioner’s satisfaction that the manufacturer’s annual gross revenue 2from insulin sales in this state does not exceed $2,000,000. AB50-ASA2-AA16,20,73(b) A manufacturer may not be required to make an insulin product available 4under sub. (2) or (3) if the wholesale acquisition cost of the insulin product does not 5exceed $8, as adjusted annually based on the U.S. consumer price index for all 6urban consumers, U.S. city average, per milliliter or the applicable national council 7for prescription drug programs’ plan billing unit. AB50-ASA2-AA16,20,108(5) Confidentiality. All medical information solicited or obtained by any 9person under this section shall be subject to the applicable provisions of state law 10relating to confidentiality of medical information, including s. 610.70. AB50-ASA2-AA16,20,1611(6) Reimbursement prohibition. No person, including a manufacturer, 12pharmacy, pharmacist, or 3rd-party administrator, as part of participating in an 13urgent need safety net program or patient assistance program may request or seek, 14or cause another person to request or seek, any reimbursement or other 15compensation for which payment may be made in whole or in part under a federal 16health care program, as defined in 42 USC 1320a-7b (f). AB50-ASA2-AA16,20,1917(7) Reports. (a) Annually, no later than March 1, each manufacturer shall 18report to the commissioner all of the following information for the previous calendar 19year: AB50-ASA2-AA16,20,21201. The number of individuals who received insulin under the manufacturer’s 21urgent need safety net program. AB50-ASA2-AA16,21,2222. The number of individuals who sought assistance under the
1manufacturer’s patient assistance program and the number of individuals who 2were determined to be ineligible under sub. (3) (c) 4. AB50-ASA2-AA16,21,433. The wholesale acquisition cost of the insulin provided by the manufacturer 4through the urgent need safety net program and patient assistance program. AB50-ASA2-AA16,21,85(b) Annually, no later than April 1, the commissioner shall submit to the 6governor and the chief clerk of each house of the legislature, for distribution to the 7legislature under s. 13.172 (2), a report on the urgent need safety net programs and 8patient assistance programs that includes all of the following: AB50-ASA2-AA16,21,991. The information provided to the commissioner under par. (a). AB50-ASA2-AA16,21,11102. The penalties assessed under sub. (9) during the previous calendar year, 11including the name of the manufacturer and amount of the penalty. AB50-ASA2-AA16,21,1612(8) Additional responsibilities of commissioner. (a) Application form. 13The commissioner shall make the application form described in sub. (2) (c) 1. a. 14available on the office’s website and shall make the form available to pharmacies 15and health care providers who prescribe or dispense insulin, hospital emergency 16departments, urgent care clinics, and community health clinics. AB50-ASA2-AA16,21,1917(b) Public outreach. 1. The commissioner shall conduct public outreach to 18create awareness of the urgent need safety net programs and patient assistance 19programs. AB50-ASA2-AA16,21,21202. The commissioner shall develop and make available on the office’s website 21an information sheet that contains all of the following information: AB50-ASA2-AA16,21,2322a. A description of how to access insulin through an urgent need safety net 23program. AB50-ASA2-AA16,22,2
1b. A description of how to access insulin through a patient assistance 2program. AB50-ASA2-AA16,22,43c. Information on how to contact a navigator for assistance in accessing 4insulin through an urgent need safety net program or patient assistance program. AB50-ASA2-AA16,22,65d. Information on how to contact the commissioner if a manufacturer 6determines that an individual is not eligible for a patient assistance program. AB50-ASA2-AA16,22,87e. A notification that an individual may contact the commissioner for more 8information or assistance in accessing ongoing affordable insulin options. AB50-ASA2-AA16,22,159(c) Navigators. The commissioner shall develop a training program to provide 10navigators with information and the resources necessary to assist individuals in 11accessing appropriate long-term insulin options. The commissioner shall compile a 12list of navigators that have completed the training program and are available to 13assist individuals in accessing affordable insulin coverage options. The list shall be 14made available on the office’s website and to pharmacies and health care 15practitioners who dispense and prescribe insulin. AB50-ASA2-AA16,22,2116(d) Satisfaction surveys. 1. The commissioner shall develop and conduct a 17satisfaction survey of individuals who have accessed insulin through urgent need 18safety net programs and patient assistance programs. The survey shall ask 19whether the individual is still in need of a long-term solution for affordable insulin 20and shall include questions about the individual’s satisfaction with all of the 21following, if applicable: AB50-ASA2-AA16,22,2222a. Accessibility to urgent-need insulin. AB50-ASA2-AA16,23,2
1b. Adequacy of the information sheet and list of navigators received from the 2pharmacy. AB50-ASA2-AA16,23,33c. Helpfulness of a navigator. AB50-ASA2-AA16,23,54d. Ease of access in applying for a patient assistance program and receiving 5insulin from the pharmacy under the patient assistance program. AB50-ASA2-AA16,23,962. The commissioner shall develop and conduct a satisfaction survey of 7pharmacies that have dispensed insulin through urgent need safety net programs 8and patient assistance programs. The survey shall include questions about the 9pharmacy’s satisfaction with all of the following, if applicable: AB50-ASA2-AA16,23,1110a. Timeliness of reimbursement from manufacturers for insulin dispensed by 11the pharmacy under urgent need safety net programs. AB50-ASA2-AA16,23,1212b. Ease in submitting insulin orders to manufacturers. AB50-ASA2-AA16,23,1313c. Timeliness of receiving insulin orders from manufacturers. AB50-ASA2-AA16,23,15143. The commissioner may contract with a nonprofit entity to develop and 15conduct the surveys under subds. 1. and 2. and to evaluate the survey results. AB50-ASA2-AA16,23,18164. No later than July 1, 2028, the commissioner shall submit to the governor 17and the chief clerk of each house of the legislature, for distribution to the legislature 18under s. 13.172 (2), a report on the results of the surveys under subds. 1. and 2.
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