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. 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-AA16,24,53609.83 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-AA16,24,2323632.895 (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-AA16,25,1613(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-AA16,25,231940.51 (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-AA16,26,5240.51 (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-AA16,26,13766.0137 (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-AA16,26,1815120.13 (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-AA16,27,85609.83 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-AA16,27,1110632.862 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. AB50-ASA2-AA16,28,83(2) Application of discounts. A disability insurance policy that offers a 4prescription drug benefit or a self-insured health plan shall apply to any calculation 5of an out-of-pocket maximum amount and to any deductible of the disability 6insurance policy or self-insured health plan for an enrollee the amount that any 7discount provided by the manufacturer of a brand name drug reduces the cost 8sharing amount charged to the enrollee for that brand name drug. AB50-ASA2-AA16,28,1010(1) Application of manufacturer discounts. AB50-ASA2-AA16,28,1611(a) For policies and plans containing provisions inconsistent with the 12treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 13609.83, and 632.862, the treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) 14(g), 185.983 (1) (intro.), 609.83, and 632.862 first applies to policy or plan years 15beginning on January 1 of the year following the year in which this paragraph takes 16effect, except as provided in par. (b). AB50-ASA2-AA16,28,2317(b) For policies or plans that are affected by a collective bargaining agreement 18containing provisions inconsistent with the treatment of ss. 40.51 (8) and (8m), 1966.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.83, and 632.862, the treatment of 20ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.83, and 21632.862 first applies to policy or plan years beginning on the effective date of this 22paragraph or on the day on which the collective bargaining agreement is newly 23established, extended, modified, or renewed, whichever is later. AB50-ASA2-AA16,29,52(1) Application of manufacturer discounts. The treatment of ss. 40.51 (8) 3and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.83, and 632.862 and 4Section 9323 (1) take effect on the first day of the 4th month beginning after 5publication.”. AB50-ASA2-AA16,29,138(1) Board on aging and long-term care medigap helpline. In the 9schedule under s. 20.005 (3) for the appropriation to the board on aging and long-10term care under s. 20.432 (1) (kb), the dollar amount for fiscal year 2025-26 is 11increased by $100,600 and the dollar amount for fiscal year 2026-27 is increased by 12$122,000 to support telephone counseling services provided under s. 16.009 (2) (j) 13for individuals seeing information on medicare supplemental insurance policies.”. AB50-ASA2-AA16,29,1816609.712 Essential health benefits; preventive services. Defined 17network plans and preferred provider plans are subject to s. 632.895 (13m) and 18(14m).
/2025/related/amendments/ab50/aa16_asa2_ab50
true
amends
/2025/related/amendments/ab50/aa16_asa2_ab50/9337/_77
amends/2025/REG/AB50-ASA2-AA16,23,3
amends/2025/REG/AB50-ASA2-AA16,23,3
section
true