This is the preview version of the Wisconsin State Legislature site.
Please see http://docs.legis.wisconsin.gov for the production version.
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 manufacturers
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 individuals parent or legal guardian if the individual
7is under the age of 18, has a valid Wisconsin drivers 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 individuals 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 individuals
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 individuals 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 individuals 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
17individuals 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 commissioners 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 individuals insulin needs are better addressed through the use
18of the manufacturers 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 pharmacys 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 pharmacys 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 individuals
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 commissioners satisfaction that the manufacturers 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 manufacturers
21urgent need safety net program.
AB50-ASA2-AA16,21,2222. The number of individuals who sought assistance under the

1manufacturers 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 offices 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 offices 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 offices 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 individuals 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
9pharmacys 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.
AB50-ASA2-AA16,23,2319(9) Penalty. A manufacturer that violates this section may be required to
20forfeit not more than $200,000 per month of violation, with the maximum forfeiture
21increasing to $400,000 per month if the manufacturer continues to be in violation
22after 6 months and increasing to $600,000 per month if the manufacturer continues
23to be in violation after one year..
AB50-ASA2-AA16,24,1
116. At the appropriate places, insert all of the following:
AB50-ASA2-AA16,24,22Section 21. 609.83 of the statutes is amended to read:
AB50-ASA2-AA16,24,53609.83 Coverage of drugs and devices. Limited service health
4organizations, preferred provider plans, and defined network plans are subject to
5ss. 632.853, 632.861, and 632.895 (6) (b), (16t), and (16v).
AB50-ASA2-AA16,226Section 22. 632.895 (6) (title) of the statutes is amended to read:
AB50-ASA2-AA16,24,87632.895 (6) (title) Equipment and supplies for treatment of diabetes;
8insulin.
AB50-ASA2-AA16,239Section 23. 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and
10amended to read:
AB50-ASA2-AA16,24,2111632.895 (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-AA16,2422Section 24. 632.895 (6) (b) of the statutes is created to read:
AB50-ASA2-AA16,24,2323632.895 (6) (b) 1. In this paragraph:
AB50-ASA2-AA16,25,3
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-AA16,25,44b. Self-insured health plan has the meaning given in s. 632.85 (1) (c).
AB50-ASA2-AA16,25,752. 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-AA16,25,1183. 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-AA16,942312Section 9423. Effective dates; Insurance.
AB50-ASA2-AA16,25,1613(1) Cost-sharing cap on insulin. The treatment of ss. 609.83 and 632.895
14(6) (title), the renumbering and amendment of s. 632.895 (6), and the creation of s.
15632.895 (6) (b) take effect on the first day of the 4th month beginning after
16publication..
AB50-ASA2-AA16,25,171717. At the appropriate places, insert all of the following:
AB50-ASA2-AA16,25,1818Section 25. 40.51 (8) of the statutes is amended to read:
AB50-ASA2-AA16,25,231940.51 (8) Every health care coverage plan offered by the state under sub. (6)
20shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.722,
21632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835,
22632.85, 632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (3) to (6), 632.885,
23632.89, 632.895 (5m) and (8) to (17), and 632.896.
AB50-ASA2-AA16,26
1Section 26. 40.51 (8m) of the statutes is amended to read:
AB50-ASA2-AA16,26,5240.51 (8m) Every health care coverage plan offered by the group insurance
3board under sub. (7) shall comply with ss. 631.95, 632.722, 632.729, 632.746 (1) to
4(8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855,
5632.861, 632.862, 632.867, 632.885, 632.89, and 632.895 (11) to (17).
AB50-ASA2-AA16,276Section 27. 66.0137 (4) of the statutes is amended to read:
AB50-ASA2-AA16,26,13766.0137 (4) Self-insured health plans. If a city, including a 1st class city,
8or a village provides health care benefits under its home rule power, or if a town
9provides health care benefits, to its officers and employees on a self-insured basis,
10the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
11632.722, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85,
12632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (4) to (6), 632.885, 632.89,
13632.895 (9) to (17), 632.896, and 767.513 (4).
AB50-ASA2-AA16,2814Section 28. 120.13 (2) (g) of the statutes is amended to read:
AB50-ASA2-AA16,26,1815120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
1649.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.722, 632.729, 632.746 (10) (a) 2. and
17(b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.862, 632.867,
18632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).
AB50-ASA2-AA16,2919Section 29. 185.983 (1) (intro.) of the statutes is amended to read:
AB50-ASA2-AA16,27,320185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
21cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
22646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
23601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
24631.95, 632.72 (2), 632.722, 632.729, 632.745 to 632.749, 632.775, 632.79, 632.795,

1632.798, 632.85, 632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (2) to (6),
2632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609,
3620, 630, 635, 645, and 646, but the sponsoring association shall:
AB50-ASA2-AA16,304Section 30. 609.83 of the statutes is amended to read:
AB50-ASA2-AA16,27,85609.83 Coverage of drugs and devices; application of payments.
6Limited service health organizations, preferred provider plans, and defined
7network plans are subject to ss. 632.853, 632.861, 632.862, and 632.895 (16t) and
8(16v).
AB50-ASA2-AA16,319Section 31. 632.862 of the statutes is created to read:
AB50-ASA2-AA16,27,1110632.862 Application of prescription drug payments. (1) Definitions.
11In this section:
AB50-ASA2-AA16,27,1212(a) Brand name has the meaning given in s. 450.12 (1) (a).
AB50-ASA2-AA16,27,1313(b) Brand name drug means any of the following:
AB50-ASA2-AA16,27,15141. A prescription drug that contains a brand name and that has no generic
15equivalent.
AB50-ASA2-AA16,27,20162. A prescription drug that contains a brand name and has a generic
17equivalent but for which the enrollee has received prior authorization from the
18insurer offering the disability insurance policy or self-insured health plan or
19authorization from a physician to obtain the prescription drug under the disability
20insurance policy or self-insured health plan.
AB50-ASA2-AA16,27,2121(c) Disability insurance policy has the meaning given in s. 632.895 (1) (a).
AB50-ASA2-AA16,27,2222(d) Prescription drug has the meaning given in s. 450.01 (20).
AB50-ASA2-AA16,28,2
1(e) Self-insured health plan means a self-insured health plan of the state or
2a county, city, village, town, or school district.
Loading...
Loading...