This is the preview version of the Wisconsin State Legislature site.
Please see http://docs.legis.wisconsin.gov for the production version.
AB50-ASA2-AA16,47,1
1j. Pediatric services, including oral and vision care.
AB50-ASA2-AA16,47,622. Conduct a survey of employer-sponsored coverage to determine benefits
3typically covered by employers and ensure that the scope of essential health
4benefits for which coverage is required under this subsection is equal to the scope of
5benefits covered under a typical disability insurance policy offered by an employer
6to its employees.
AB50-ASA2-AA16,47,973. Ensure that essential health benefits reflect a balance among the
8categories described in subd. 1. such that benefits are not unduly weighted toward
9one category.
AB50-ASA2-AA16,47,11104. Ensure that essential health benefit coverage is provided with no or limited
11cost-sharing requirements.
AB50-ASA2-AA16,47,15125. Require that disability insurance policies and self-insured health plans do
13not make coverage decisions, determine reimbursement rates, establish incentive
14programs, or design benefits in ways that discriminate against individuals because
15of their age, disability, or expected length of life.
AB50-ASA2-AA16,47,18166. Establish essential health benefits in a way that takes into account the
17health care needs of diverse segments of the population, including women, children,
18persons with disabilities, and other groups.
AB50-ASA2-AA16,47,22197. Ensure that essential health benefits established under this subsection are
20not subject to a coverage denial based on an insureds or plan participants age,
21expected length of life, present or predicted disability, degree of dependency on
22medical care, or quality of life.
AB50-ASA2-AA16,48,6238. Require that disability insurance policies and self-insured health plans

1cover emergency department services that are essential health benefits without
2imposing any requirement to obtain prior authorization for those services and
3without limiting coverage for services provided by an emergency services provider
4that is not in the provider network of a policy or plan in a way that is more
5restrictive than requirements or limitations that apply to emergency services
6provided by a provider that is in the provider network of the policy or plan.
AB50-ASA2-AA16,48,1179. Require a disability insurance policy or self-insured health plan to apply to
8emergency department services that are essential health benefits provided by an
9emergency department provider that is not in the provider network of the policy or
10plan the same copayment amount or coinsurance rate that applies if those services
11are provided by a provider that is in the provider network of the policy or plan.
AB50-ASA2-AA16,48,1312(d) The commissioner shall periodically update, by rule, the essential health
13benefits under this subsection to address any gaps in access to coverage.
AB50-ASA2-AA16,48,1814(e) If an essential health benefit is also subject to mandated coverage
15elsewhere under this section and the coverage requirements are not identical, the
16disability insurance policy or self-insured health plan shall provide coverage under
17whichever subsection provides the insured or plan participant with more
18comprehensive coverage of the medical condition, item, or service.
AB50-ASA2-AA16,48,2219(f) Nothing in this subsection or rules promulgated under this subsection
20prohibits a disability insurance policy or a self-insured health plan from providing
21benefits in excess of the essential health benefit coverage required under this
22subsection.
AB50-ASA2-AA16,49,2
1(g) This subsection does not apply to any disability insurance policy that is
2described in s. 632.745 (11) (b) 1. to 12.
AB50-ASA2-AA16,603Section 60. 632.895 (16m) (b) of the statutes is amended to read:
AB50-ASA2-AA16,49,84632.895 (16m) (b) The coverage required under this subsection may be subject
5to any limitations, or exclusions, or cost-sharing provisions that apply generally
6under the disability insurance policy or self-insured health plan. The coverage
7required under this subsection may not be subject to any deductibles, copayments,
8or coinsurance.
AB50-ASA2-AA16,619Section 61. 632.895 (17) (b) 2. of the statutes is amended to read:
AB50-ASA2-AA16,49,1410632.895 (17) (b) 2. Outpatient consultations, examinations, procedures, and
11medical services that are necessary to prescribe, administer, maintain, or remove a
12contraceptive, if covered for any other drug benefits under the policy or plan
13sterilization procedures, and patient education and counseling for all females with
14reproductive capacity.
AB50-ASA2-AA16,6215Section 62. 632.895 (17) (c) of the statutes is amended to read:
AB50-ASA2-AA16,50,716632.895 (17) (c) Coverage under par. (b) may be subject only to the exclusions,
17and limitations, or cost-sharing provisions that apply generally to the coverage of
18outpatient health care services, preventive treatments and services, or prescription
19drugs and devices that is provided under the policy or self-insured health plan. A
20disability insurance policy or self-insured health plan may not apply a deductible or
21impose a copayment or coinsurance to at least one of each type of contraceptive
22method approved by the federal food and drug administration for which coverage is
23required under this subsection. The disability insurance policy or self-insured

1health plan may apply reasonable medical management to a method of
2contraception to limit coverage under this subsection that is provided without being
3subject to a deductible, copayment, or coinsurance to prescription drugs without a
4brand name. The disability insurance policy or self-insured health plan may apply
5a deductible or impose a copayment or coinsurance for coverage of a contraceptive
6that is prescribed for a medical need if the services for the medical need would
7otherwise be subject to a deductible, copayment, or coinsurance.
AB50-ASA2-AA16,638Section 63. 632.897 (11) (a) of the statutes is amended to read:
AB50-ASA2-AA16,50,179632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may
10promulgate rules establishing standards requiring insurers to provide continuation
11of coverage for any individual covered at any time under a group policy who is a
12terminated insured or an eligible individual under any federal program that
13provides for a federal premium subsidy for individuals covered under continuation
14of coverage under a group policy, including rules governing election or extension of
15election periods, notice, rates, premiums, premium payment, application of
16preexisting condition exclusions, election of alternative coverage, and status as an
17eligible individual, as defined in s. 149.10 (2t), 2011 stats.
AB50-ASA2-AA16,932318Section 9323. Initial applicability; Insurance.
AB50-ASA2-AA16,50,2019(1) Coverage of individuals with preexisting conditions, essential
20health benefits, and preventive services.
AB50-ASA2-AA16,51,421(a) For policies and plans containing provisions inconsistent with these
22sections, the treatment of ss. 632.728, 632.746 (1) (a) and (b), (2) (a), (c), (d), and (e),
23(3) (a) and (d) 1., 2., and 3., (5), and (8) (a) (intro.), 632.748 (2), 632.76 (2) (a) and (ac)

11. and 2., 632.795 (4) (a), 632.895 (8) (d), (13m), (14) (a) 1. i., j., and k. to o., (b), (c),
2and (d) 3., (14m), (16m) (b), and (17) (b) 2. and (c), and 632.897 (11) (a) first applies
3to policy or plan years beginning on January 1 of the year following the year in
4which this paragraph takes effect, except as provided in par. (b).
AB50-ASA2-AA16,51,135(b) For policies and plans that are affected by a collective bargaining
6agreement containing provisions inconsistent with these sections, the treatment of
7ss. 632.728, 632.746 (1) (a) and (b), (2) (a), (c), (d), and (e), (3) (a) and (d) 1., 2., and
83., (5), and (8) (a) (intro.), 632.748 (2), 632.76 (2) (a) and (ac) 1. and 2., 632.795 (4)
9(a), 632.895 (8) (d), (13m), (14) (a) 1. i., j., and k. to o., (b), (c), and (d) 3., (14m), (16m)
10(b), and (17) (b) 2. and (c), and 632.897 (11) (a) first applies to policy or plan years
11beginning on the effective date of this paragraph or on the day on which the
12collective bargaining agreement is entered into, extended, modified, or renewed,
13whichever is later.
AB50-ASA2-AA16,942314Section 9423. Effective dates; Insurance.
AB50-ASA2-AA16,51,2115(1) Coverage of individuals with preexisting conditions, essential
16health benefits, and preventive services. The treatment of ss. 632.728,
17632.746 (1) (a) and (b), (2) (a), (c), (d), and (e), (3) (a) and (d) 1., 2., and 3., (5), and (8)
18(a) (intro.), 632.748 (2), 632.76 (2) (a) and (ac) 1. and 2., 632.795 (4) (a), 632.895 (8)
19(d), (13m), (14) (a) 1. i., j., and k. to o., (b), (c), and (d) 3., (14m), (16m) (b), and (17) (b)
202. and (c), and 632.897 (11) (a) and Section 9323 (1) of this act take effect on the
21first day of the 4th month beginning after publication..
AB50-ASA2-AA16,51,222220. At the appropriate places, insert all of the following:
AB50-ASA2-AA16,51,2323Section 64. 20.145 (1) (g) 5. of the statutes is created to read:
AB50-ASA2-AA16,52,4
120.145 (1) (g) 5. All moneys received from the regulation of pharmacy benefit
2managers, pharmacy benefit management brokers, pharmacy benefit management
3consultants, pharmacy services administration organizations, and pharmaceutical
4representatives..
AB50-ASA2-AA16,52,5521. At the appropriate places, insert all of the following:
AB50-ASA2-AA16,52,66Section 65. 15.07 (3) (bm) 7. of the statutes is created to read:
AB50-ASA2-AA16,52,8715.07 (3) (bm) 7. The prescription drug affordability review board shall meet
8at least 4 times each year.
AB50-ASA2-AA16,669Section 66. 15.735 of the statutes is created to read:
AB50-ASA2-AA16,52,121015.735 Same; attached board. (1) There is created a prescription drug
11affordability review board attached to the office of the commissioner of insurance
12under s. 15.03. The board shall consist of the following members:
AB50-ASA2-AA16,52,1313(a) The commissioner of insurance or his or her designee.
AB50-ASA2-AA16,52,1714(b) Two members appointed for 4-year terms who represent the
15pharmaceutical drug industry, including pharmaceutical drug manufacturers and
16wholesalers. At least one of the members appointed under this paragraph shall be
17a licensed pharmacist.
AB50-ASA2-AA16,52,1918(c) Two members appointed for 4-year terms who represent the health
19insurance industry, including insurers and pharmacy benefit managers.
AB50-ASA2-AA16,52,2320(d) Two members appointed for 4-year terms who represent the health care
21industry, including hospitals, physicians, pharmacies, and pharmacists. At least
22one of the members appointed under this paragraph shall be a licensed
23practitioner.
AB50-ASA2-AA16,53,2
1(e) Two members appointed for 4-year terms who represent the interests of
2the public.
AB50-ASA2-AA16,53,53(2) A member appointed under sub. (1), except for a member appointed under
4sub. (1) (b), may not be an employee of, a board member of, or a consultant to a drug
5manufacturer or trade association for drug manufacturers.
AB50-ASA2-AA16,53,106(3) Any conflict of interest, including any financial or personal association,
7that has the potential to bias or has the appearance of biasing an individuals
8decision in matters related to the board or the conduct of the boards activities shall
9be considered and disclosed when appointing that individual to the board under
10sub. (1).
AB50-ASA2-AA16,6711Section 67. Subchapter VI (title) of chapter 601 [precedes 601.78] of the
12statutes is created to read:
AB50-ASA2-AA16,53,1414SUBCHAPTER VI
AB50-ASA2-AA16,53,1515PRESCRIPTION DRUG
AB50-ASA2-AA16,53,1616AFFORDABILITY REVIEW BOARD
AB50-ASA2-AA16,6817Section 68. 601.78 of the statutes is created to read:
AB50-ASA2-AA16,53,1818601.78 Definitions. In this subchapter:
AB50-ASA2-AA16,53,2019(1) Biologic means a drug that is produced or distributed in accordance with
20a biologics license application approved under 21 CFR 601.20.
AB50-ASA2-AA16,53,2221(2) Biosimilar means a drug that is produced or distributed in accordance
22with a biologics license application approved under 42 USC 262 (k) (3).
AB50-ASA2-AA16,54,2
1(3) Board means the prescription drug affordability review board
2established under s. 15.735 (1).
AB50-ASA2-AA16,54,53(4) Brand name drug means a drug that is produced or distributed in
4accordance with an original new drug application approved under 21 USC 355 (c),
5other than an authorized generic drug, as defined in 42 CFR 447.502.
AB50-ASA2-AA16,54,96(5) Financial benefit includes an honorarium, fee, stock, the value of the
7stock holdings of a member of the board or any immediate family member of the
8member of the board, and any direct financial benefit deriving from the finding of a
9review conducted under s. 601.79.
AB50-ASA2-AA16,54,1010(6) Generic drug means any of the following:
AB50-ASA2-AA16,54,1211(a) A retail drug that is marketed or distributed in accordance with an
12abbreviated new drug application approved under 21 USC 355 (j).
AB50-ASA2-AA16,54,1313(b) An authorized generic drug, as defined in 42 CFR 447.502.
AB50-ASA2-AA16,54,1514(c) A drug that entered the market prior to 1962 and was not originally
15marketed under a new drug application.
AB50-ASA2-AA16,54,1816(7) Immediate family member means a spouse, grandparent, parent,
17sibling, child, stepchild, or grandchild or the spouse of a grandparent, parent,
18sibling, child, stepchild, or grandchild.
AB50-ASA2-AA16,54,1919(8) Manufacturer means an entity that does all of the following:
AB50-ASA2-AA16,54,2220(a) Engages in the manufacture of a prescription drug product or enters into
21a lease with another entity to market and distribute a prescription drug product
22under the entitys own name.
AB50-ASA2-AA16,55,2
1(b) Sets or changes the wholesale acquisition cost of the prescription drug
2product described in par. (a).
AB50-ASA2-AA16,55,33(9) Pharmacy benefit manager has the meaning given in s. 632.865 (1) (c).
AB50-ASA2-AA16,55,54(10) Prescription drug product means a brand name drug, a generic drug, a
5biologic, or a biosimilar.
AB50-ASA2-AA16,696Section 69. 601.785 of the statutes is created to read:
AB50-ASA2-AA16,55,117601.785 Prescription drug affordability review board. (1) Mission.
8The purpose of the board is to protect state residents, the state, local governments,
9health plans, health care providers, pharmacies licensed in this state, and other
10stakeholders of the health care system in this state from the high costs of
11prescription drug products.
AB50-ASA2-AA16,55,1212(2) Powers and duties. (a) The board shall do all of the following:
AB50-ASA2-AA16,55,15131. Meet in open session at least 4 times per year to review prescription drug
14product pricing information in the manner described in subd. 2., except that the
15chairperson may cancel or postpone a meeting if there is no business to transact.
AB50-ASA2-AA16,55,17162. To the extent practicable, access and assess pricing information for
17prescription drug products by doing all of the following:
AB50-ASA2-AA16,55,2018a. Accessing and assessing information from other states by entering into
19memoranda of understanding with other states to which manufacturers report
20pricing information.
AB50-ASA2-AA16,55,2121b. Assessing spending for specific prescription drug products in this state.
AB50-ASA2-AA16,55,2222c. Accessing other available pricing information.
AB50-ASA2-AA16,55,2323(b) The board may do any of the following:
AB50-ASA2-AA16,56,1
11. Promulgate rules for the administration of this subchapter.
AB50-ASA2-AA16,56,622. Enter into a contract with an independent 3rd party for any service
3necessary to carry out the powers and duties of the board. Unless written
4permission is granted by the board, any person with whom the board contracts may
5not release, publish, or otherwise use any information to which the person has
6access under the contract.
AB50-ASA2-AA16,56,97(c) The board shall establish and maintain a website to provide public notices
8and make meeting materials available under sub. (3) (a) and to disclose conflicts of
9interest under sub. (4) (d).
AB50-ASA2-AA16,56,1310(3) Meeting requirements. (a) Pursuant to s. 19.84, the board shall provide
11public notice of each board meeting at least 2 weeks prior to the meeting and shall
12make the materials for each meeting publicly available at least one week prior to
13the meeting.
AB50-ASA2-AA16,56,1614(b) Notwithstanding s. 19.84 (2), the board shall provide an opportunity for
15public comment at each open meeting and shall provide the public with the
16opportunity to provide written comments on pending decisions of the board.
AB50-ASA2-AA16,56,1917(c) Notwithstanding subch. V of ch. 19, any portion of a meeting of the board
18concerning proprietary data and information shall be conducted in closed session
19and shall in all respects remain confidential.
AB50-ASA2-AA16,56,2120(d) The board may allow expert testimony at any meeting, including when the
21board meets in closed session.
AB50-ASA2-AA16,57,222(4) Conflicts of interest. (a) A member of the board shall recuse himself
23or herself from a decision by the board relating to a prescription drug product if the

1member or an immediate family member of the member has received or could
2receive any of the following:
AB50-ASA2-AA16,57,431. A direct financial benefit deriving from a determination, or a finding of a
4study or review, by the board relating to the prescription drug product.
AB50-ASA2-AA16,57,752. A financial benefit in excess of $5,000 in a calendar year from any person
6who owns, manufactures, or provides a prescription drug product to be studied or
7reviewed by the board.
AB50-ASA2-AA16,57,118(b) A conflict of interest under this subsection shall be disclosed by the board
9when hiring board staff, by the appointing authority when appointing members to
10the board, and by the board when a member of the board is recused from any
11decision relating to a review of a prescription drug product.
AB50-ASA2-AA16,57,1512(c) A conflict of interest under this subsection shall be disclosed no later than
135 days after the conflict is identified, except that, if the conflict is identified within
145 days of an open meeting of the board, the conflict shall be disclosed prior to the
15meeting.
AB50-ASA2-AA16,57,2016(d) The board shall disclose a conflict of interest under this subsection on the
17boards website unless the chairperson of the board recuses the member from a
18final decision relating to a review of the prescription drug product. The disclosure
19shall include the type, nature, and magnitude of the interests of the member
20involved.
AB50-ASA2-AA16,57,2321(e) A member of the board or a 3rd-party contractor may not accept any gift or
22donation of services or property that indicates a potential conflict of interest or has
23the appearance of biasing the work of the board.
AB50-ASA2-AA16,70
1Section 70. 601.79 of the statutes is created to read:
AB50-ASA2-AA16,58,32601.79 Drug cost affordability review. (1) Identification of drugs.
3The board shall identify prescription drug products that are any of the following:
Loading...
Loading...