Amendment AA8-ASA2-AB50

AB50-ASA2-AA8,145,22 (e) Other prescription drug products, including drugs to address public health emergencies, that may create affordability challenges for the health care system and patients in this state.

AB50-ASA2-AA8,146,4 (2) Affordability review. (a) After identifying prescription drug products under sub. (1), the board shall determine whether to conduct an affordability review for each identified prescription drug product by seeking stakeholder input about the prescription drug product and considering the average patient cost share of the prescription drug product.

AB50-ASA2-AA8,146,10 (b) The information used to conduct an affordability review under par. (a) may include any document and research related to the manufacturer’s selection of the introductory price or price increase of the prescription drug product, including life cycle management, net average price in this state, market competition and context, projected revenue, and the estimated value or cost-effectiveness of the prescription drug product.

AB50-ASA2-AA8,146,13 (c) The failure of a manufacturer to provide the board with information for an affordability review under par. (b) does not affect the authority of the board to conduct the review.

AB50-ASA2-AA8,146,21 (3) Affordability challenge. When conducting an affordability review of a prescription drug product under sub. (2), the board shall determine whether use of the prescription drug product that is fully consistent with the labeling approved by the federal food and drug administration or standard medical practice has led or will lead to an affordability challenge for the health care system in this state, including high out-of-pocket costs for patients. To the extent practicable, in determining whether a prescription drug product has led or will lead to an affordability challenge, the board shall consider all of the following factors:

AB50-ASA2-AA8,146,23 (a) The wholesale acquisition cost for the prescription drug product sold in this state.

AB50-ASA2-AA8,147,4 (b) The average monetary price concession, discount, or rebate the manufacturer provides, or is expected to provide, to health plans in this state as reported by manufacturers and health plans, expressed as a percentage of the wholesale acquisition cost for the prescription drug product under review.

AB50-ASA2-AA8,147,8 (c) The total amount of the price concessions, discounts, and rebates the manufacturer provides to each pharmacy benefit manager for the prescription drug product under review, as reported by the manufacturer and pharmacy benefit manager and expressed as a percentage of the wholesale acquisition cost.

AB50-ASA2-AA8,147,10 (d) The price at which therapeutic alternatives to the prescription drug product have been sold in this state.

AB50-ASA2-AA8,147,13 (e) The average monetary concession, discount, or rebate the manufacturer provides or is expected to provide to health plan payors and pharmacy benefit managers in this state for therapeutic alternatives to the prescription drug product.

AB50-ASA2-AA8,147,16 (f) The costs to health plans based on patient access consistent with labeled indications by the federal food and drug administration and recognized standard medical practice.

AB50-ASA2-AA8,147,18 (g) The impact on patient access resulting from the cost of the prescription drug product relative to insurance benefit design.

AB50-ASA2-AA8,147,20 (h) The current or expected dollar value of drug-specific patient access programs that are supported by the manufacturer.

AB50-ASA2-AA8,147,23 (i) The relative financial impacts to health, medical, or social services costs that can be quantified and compared to baseline effects of existing therapeutic alternatives to the prescription drug product.

AB50-ASA2-AA8,148,2 (j) The average patient copay or other cost sharing for the prescription drug product in this state.

AB50-ASA2-AA8,148,3 (k) Any information a manufacturer chooses to provide.

AB50-ASA2-AA8,148,4 (L) Any other factors as determined by the board by rule.

AB50-ASA2-AA8,148,8 (4) Upper payment limit. (a) If the board determines under sub. (3) that use of a prescription drug product has led or will lead to an affordability challenge, the board shall establish an upper payment limit for the prescription drug product after considering all of the following:

AB50-ASA2-AA8,148,9 1. The cost of administering the drug.

AB50-ASA2-AA8,148,10 2. The cost of delivering the drug to consumers.

AB50-ASA2-AA8,148,11 3. Other relevant administrative costs related to the drug.

AB50-ASA2-AA8,148,17 (b) For a prescription drug product identified in sub. (1) (b) or (d) 2., the board shall solicit information from the manufacturer regarding the price increase. To the extent that the price increase is not a result of the need for increased manufacturing capacity or other effort to improve patient access during a public health emergency, the board shall establish an upper payment limit under par. (a) that is equal to the cost to consumers prior to the price increase.

AB50-ASA2-AA8,148,21 (c) 1. The upper payment limit established under this subsection shall apply to all purchases and payor reimbursements of the prescription drug product dispensed or administered to individuals in this state in person, by mail, or by other means.

AB50-ASA2-AA8,149,9 2. Notwithstanding subd. 1., while state-sponsored and state-regulated health plans and health programs shall limit drug reimbursements and drug payment to no more than the upper payment limit established under this subsection, a plan subject to the Employee Retirement Income Security Act of 1974 or Part D of Medicare under 42 USC 1395w-101 et seq. may choose to reimburse more than the upper payment limit. A provider who dispenses and administers a prescription drug product in this state to an individual in this state may not bill a payor more than the upper payment limit to the patient regardless of whether a plan subject to the Employee Retirement Income Security Act of 1974 or Part D of Medicare under 42 USC 1395w-101 et seq. chooses to reimburse the provider above the upper payment limit.

AB50-ASA2-AA8,149,11 (5) Public inspection. Information submitted to the board under this section shall be open to public inspection only as provided under ss. 19.31 to 19.39.

AB50-ASA2-AA8,149,15 (6) No prohibition on marketing. Nothing in this section may be construed to prevent a manufacturer from marketing a prescription drug product approved by the federal food and drug administration while the prescription drug product is under review by the board.

AB50-ASA2-AA8,149,20 (7) Appeals. A person aggrieved by a decision of the board may request an appeal of the decision no later than 30 days after the board makes the determination. The board shall hear the appeal and make a final decision no later than 60 days after the appeal is requested. A person aggrieved by a final decision of the board may petition for judicial review in a court of competent jurisdiction.

AB50-ASA2-AA8,9123 Section 9123. Nonstatutory provisions; Insurance.

AB50-ASA2-AA8,150,5 (1) Staggered terms for prescription drug affordability review board. Notwithstanding the length of terms specified for the members of the prescription drug affordability review board under s. 15.735 (1) (b) to (e), 2 of the initial members shall be appointed for terms expiring on May 1, 2027; 2 of the initial members shall be appointed for terms expiring on May 1, 2028; 2 of the initial members shall be appointed for terms expiring on May 1, 2029; and 2 of the initial members shall be appointed for terms expiring on May 1, 2030.

AB50-ASA2-AA8,150,12 (2) Prescription drug importation program. The commissioner of insurance shall submit the first report required under s. 601.575 (5) by the next January 1 or July 1, whichever is earliest, that is at least 180 days after the date the prescription drug importation program is fully operational under s. 601.575 (4). The commissioner of insurance shall include in the first 3 reports submitted under s. 601.575 (5) information on the implementation of the audit functions under s. 601.575 (1) (n).

AB50-ASA2-AA8,150,15 (3) Prescription drug purchasing entity. During the 2025-27 fiscal biennium, the office of the commissioner of insurance shall conduct a study on the viability of creating or implementing a state prescription drug purchasing entity.

AB50-ASA2-AA8,9223 Section 9223. Fiscal changes; Insurance.

AB50-ASA2-AA8,151,4 (1) Office of prescription drug affordability. In the schedule under s. 20.005 (3) for the appropriation to the office of the commissioner of insurance under s. 20.145 (1) (g), the dollar amount for fiscal year 2025-26 is increased by $1,957,300 to provide $500,000 in onetime implementation costs for establishing an office of prescription drug affordability in the office of the commissioner of insurance and $1,457,300 to authorize 16.0 PR positions within the office of prescription drug affordability, including 5.0 insurance examiners, 4.0 policy initiatives advisors, 2.0 attorneys, 1.0 insurance program manager, 2.0 insurance administrators, and 2.0 operations program associates. In the schedule under s. 20.005 (3) for the appropriation to the office of the commissioner of insurance under s. 20.145 (1) (g), the dollar amount for fiscal year 2026-27 is increased by $1,871,100 to fund the positions authorized under this subsection.

AB50-ASA2-AA8,9423 Section 9423. Effective dates; Insurance.

AB50-ASA2-AA8,151,9 (1) Prescription drug affordability review board. The treatment of ss. 15.07 (3) (bm) 7., 15.735, 601.78, 601.785, and 601.79 and subch. VI (title) of ch. 601 and Section 9123 (1) of this act take effect on the first day of the 7th month beginning after publication.”.

AB50-ASA2-AA8,151,10 45. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,151,11 “Section 9248. Fiscal changes; Veterans Affairs.

AB50-ASA2-AA8,151,19 (1) Fund source transfer for claims officer positions; decrease. In the schedule under s. 20.005 (3) for the appropriation to the department of veterans affairs under s. 20.485 (1) (a), the dollar amount for fiscal year 2025-26 is decreased by $254,800 to decrease the authorized FTE positions for the department by 2.0 PR veterans claims officer positions. In the schedule under s. 20.005 (3) for the appropriation to the department of veterans affairs under s. 20.485 (1) (a), the dollar amount for fiscal year 2026-27 is decreased by $254,800 due to the position reduction under this subsection.

AB50-ASA2-AA8,152,3 (2) Fund source transfer for claims officer positions; increase. In the schedule under s. 20.005 (3) for the appropriation to the department of veterans affairs under s. 20.485 (2) (u), the dollar amount for fiscal year 2025-26 is increased by $254,800 to to increase the authorized FTE positions for the department by 2.0 SEG veterans claims officer positions.. In the schedule under s. 20.005 (3) for the appropriation to the department of veterans affairs under s. 20.485 (2) (u), the dollar amount for fiscal year 2026-27 is increased by $254,800 to provide funding for the positions authorized under this subsection.”.

AB50-ASA2-AA8,152,4 46. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,152,6 “Section 9202. Fiscal changes; Agriculture, Trade and Consumer Protection.

AB50-ASA2-AA8,152,11 (1) Tribal food security program. In the schedule under s. 20.005 (3) for the appropriation to the department of agriculture, trade and consumer protection under s. 20.115 (4) (k), the dollar amount for fiscal year 2025-26 is increased by $2,000,000 and the dollar amount for fiscal year 2026-27 is increased by $2,000,000 for the tribal elder community food box program under s. 93.485.”.

AB50-ASA2-AA8,152,12 47. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,152,13 “Section 271. 49.175 (1) (a) of the statutes is amended to read:

AB50-ASA2-AA8,152,17 49.175 (1) (a) Wisconsin Works benefits. For Wisconsin Works benefits, $37,000,000 $26,806,500 in fiscal year 2021-22 2025-26 and $34,000,000 $26,987,700 in fiscal year 2022-23. In fiscal year 2023-24, for such benefits, $28,000,000. In fiscal year 2024-25, for such benefits, $29,000,000 2026-27.

AB50-ASA2-AA8,272 Section 272. 49.175 (1) (b) of the statutes is amended to read:

AB50-ASA2-AA8,152,22 49.175 (1) (b) Wisconsin Works agency contracts; job access loans. For contracts with Wisconsin Works agencies under s. 49.143 and for job access loans under s. 49.147 (6), $54,009,700 $58,892,400 in fiscal year 2021-22 2025-26 and $57,071,200 $59,071,200 in each fiscal year thereafter 2026-27.

AB50-ASA2-AA8,273 Section 273. 49.175 (1) (f) of the statutes is amended to read:

AB50-ASA2-AA8,153,4 49.175 (1) (f) Homeless case management services grants. For grants to shelter facilities under s. 16.3085, $500,000 $1,000,000 in each fiscal year. All moneys allocated under this paragraph shall be credited to the appropriation account under s. 20.505 (7) (kg).

AB50-ASA2-AA8,274 Section 274. 49.175 (1) (g) of the statutes is amended to read:

AB50-ASA2-AA8,153,11 49.175 (1) (g) State administration of public assistance programs and overpayment collections. For state administration of public assistance programs and the collection of public assistance overpayments, $17,231,100 $25,258,600 in fiscal year 2021-22 2025-26 and $17,482,300 $25,707,800 in fiscal year 2022-23. In fiscal year 2023-24, for such purposes, $19,015,300. In fiscal year 2024-25, for such purposes, $19,424,300 2026-27.

AB50-ASA2-AA8,275 Section 275. 49.175 (1) (i) of the statutes is amended to read:

AB50-ASA2-AA8,153,16 49.175 (1) (i) Emergency assistance. For emergency assistance under s. 49.138 and for transfer to the department of administration for low-income energy or weatherization assistance programs, $6,000,000 $10,414,400 in each fiscal year 2025-26 and $10,141,300 in fiscal year 2026-27.

AB50-ASA2-AA8,276 Section 276. 49.175 (1) (j) of the statutes is amended to read:

AB50-ASA2-AA8,153,21 49.175 (1) (j) Grants for providing civil legal services. For the grants under s. 49.1635 (5) to Wisconsin Trust Account Foundation, Inc., for distribution to programs that provide civil legal services to low-income families, $500,000 $4,500,000 in each fiscal year.

AB50-ASA2-AA8,277 Section 277. 49.175 (1) (k) of the statutes is amended to read:

AB50-ASA2-AA8,154,2 49.175 (1) (k) Transform Milwaukee and Transitional Jobs programs. For contract costs under the Transform Milwaukee Jobs program and the Transitional Jobs program under s. 49.163, $9,500,000 $12,475,000 in each fiscal year.

AB50-ASA2-AA8,278 Section 278. 49.175 (1) (Lm) of the statutes is amended to read:

AB50-ASA2-AA8,154,7 49.175 (1) (Lm) Jobs for America’s Graduates. For grants to the Jobs for America’s Graduates-Wisconsin to fund programs that improve social, academic, and employment skills of youth who are eligible to receive temporary assistance for needy families under 42 USC 601 et seq., in each fiscal year, $1,000,000 $2,000,000.

AB50-ASA2-AA8,279 Section 279. 49.175 (1) (Lp) of the statutes is repealed.

AB50-ASA2-AA8,280 Section 280. 49.175 (1) (ms) of the statutes is created to read:

AB50-ASA2-AA8,154,12 49.175 (1) (ms) Child support debt reduction. For the child support debt reduction program for noncustodial parents under s. 49.226, $3,472,000 in fiscal year 2025-26 and $6,944,000 in fiscal year 2026-27.

AB50-ASA2-AA8,281 Section 281. 49.175 (1) (q) of the statutes is amended to read:

AB50-ASA2-AA8,154,19 49.175 (1) (q) Child care state administration and licensing activities. For state administration of child care programs under s. 49.155 and for child care licensing activities, $42,117,800 $52,983,800 in fiscal year 2021-22 2025-26 and $41,803,100 $53,723,400 in fiscal year 2022-23. In fiscal year 2023-24, for such programs and activities, $45,796,000. In fiscal year 2024-25, for such programs and activities, $45,570,300 2026-27.

AB50-ASA2-AA8,282 Section 282. 49.175 (1) (qm) of the statutes is amended to read:

AB50-ASA2-AA8,154,24 49.175 (1) (qm) Quality care for quality kids. For the child care quality improvement activities specified in ss. 49.133, 49.155 (1g) and 49.257, $16,683,700 $49,446,300 in each fiscal year 2022-23. In fiscal year 2023-24, for such activities, $28,518,700. In fiscal year 2024-25, for such activities, $46,018,700.

AB50-ASA2-AA8,283 Section 283. 49.175 (1) (r) of the statutes is amended to read:

AB50-ASA2-AA8,155,6 49.175 (1) (r) Children of recipients of supplemental security income. For payments made under s. 49.775 for the support of the dependent children of recipients of supplemental security income, $18,564,700 $19,262,100 in each fiscal year 2021-22 and $18,145,000 in fiscal year 2022-23. In fiscal year 2023-24, for such payments, $9,699,900. In fiscal year 2024-25, for such payments, $10,990,400.

AB50-ASA2-AA8,284 Section 284. 49.175 (1) (s) of the statutes is amended to read:

AB50-ASA2-AA8,155,16 49.175 (1) (s) Kinship care and long-term kinship care assistance. For kinship care and long-term kinship care payments under s. 48.57 (3m) (am) and (3n) (am), for assessments to determine eligibility for those payments, and for agreements under s. 48.57 (3t) with the governing bodies of Indian tribes for the administration of the kinship care and long-term kinship care programs within the boundaries of the reservations of those tribes, $28,727,100 $45,686,700 in fiscal year 2021-22 2025-26 and $31,441,800 $53,125,600 in fiscal year 2022-23. In fiscal year 2023-24, for such payments, $31,719,200. In fiscal year 2024-25, for such payments, $35,661,000 2026-27.

AB50-ASA2-AA8,285 Section 285. 49.175 (1) (z) of the statutes is amended to read:

AB50-ASA2-AA8,156,6 49.175 (1) (z) Grants to the Boys and Girls Clubs of America. For grants to the Wisconsin Chapter of the Boys and Girls Clubs of America to fund programs that improve social, academic, and employment skills of youth who are eligible to receive temporary assistance for needy families under 42 USC 601 et seq., focusing on study habits, intensive tutoring in math and English, and exposure to career options and role models, $2,807,000 $9,507,000 in each fiscal year. Grants provided under this paragraph may not be used by the grant recipient to replace funding for programs that are being funded, when the grant proceeds are received, with moneys other than those from the appropriations specified in sub. (1) (intro.). The total amount of the grants includes funds for the BE GREAT: Graduate program in the amount of matching funds that the program provides, up to $1,532,000 in each fiscal year, to be used only for activities for which federal Temporary Assistance for Needy Families block grant moneys may be used.

AB50-ASA2-AA8,286 Section 286. 49.175 (1) (zh) of the statutes is amended to read:

AB50-ASA2-AA8,156,13 49.175 (1) (zh) Earned income tax credit supplement. For the transfer of moneys from the appropriation account under s. 20.437 (2) (md) to the appropriation account under s. 20.835 (2) (kf) for the earned income tax credit, $63,600,000 $100,907,800 in fiscal year 2021-22 2025-26 and $66,600,000 $101,558,500 in fiscal year 2022-23. In fiscal year 2023-24, for such purposes, $61,725,000. In fiscal year 2024-25, for such purposes, $65,002,000 2026-27.

AB50-ASA2-AA8,9206 Section 9206. Fiscal changes; Children and Families.

AB50-ASA2-AA8,156,21 (1) Public assistance and local assistance allocations. In the schedule under s. 20.005 (3) for the appropriation to the department of children and families under s. 20.437 (1) (md), the dollar amount for fiscal year 2025-26 is increased by $100,525,700 to increase allocations under s. 49.175 (1). In the schedule under s. 20.005 (3) for the appropriation to the department of children and families under s. 20.437 (1) (md), the dollar amount for fiscal year 2026-27 is increased by $133,892,600 to increase allocations under s. 49.175 (1).”.

AB50-ASA2-AA8,156,22 48. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,156,23 “Section 9206. Fiscal changes; Children and Families.

AB50-ASA2-AA8,157,9 (1) State out-of-home care and adoptions. In the schedule under s. 20.005 (3) for the appropriation to the department of children and families under s. 20.437 (1) (dd), the dollar amount for fiscal year 2025-26 is decreased by $3,508,600 to reflect reestimates of adoption assistance, subsidized guardianship, and state foster care payments, and changes in federal claiming rates in the 2025-27 biennium. In the schedule under s. 20.005 (3) for the appropriation to the department of children and families under s. 20.437 (1) (dd), the dollar amount for fiscal year 2026-27 is decreased by $3,112,900 to reflect reestimates of adoption assistance, subsidized guardianship, and state foster care payments, and changes in federal claiming rates in the 2025-27 biennium.

AB50-ASA2-AA8,157,19 (2) State out-of-home care and adoptions. In the schedule under s. 20.005 (3) for the appropriation to the department of children and families under s. 20.437 (1) (pd), the dollar amount for fiscal year 2025-26 is decreased by $2,759,800 to reflect reestimates of adoption assistance, subsidized guardianship, and state foster care payments, and changes in the federal claiming rates in the 2025-27 biennium. In the schedule under s. 20.005 (3) for the appropriation to the department of children and families under s. 20.437 (1) (pd), the dollar amount for fiscal year 2026-27 is decreased by $2,963,800 to reflect reestimates of adoption assistance, subsidized guardianship, and state foster care payments, and changes in the federal claiming rates in the 2025-27 biennium.”.

AB50-ASA2-AA8,157,20 49. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,157,21 “Section 9206. Fiscal changes; Children and Families.

AB50-ASA2-AA8,158,5 (1) Office of legal counsel; GPR funding. In the schedule under s. 20.005 (3) for the appropriation to the department of children and families under s. 20.437 (1) (a), the dollar amount for fiscal year 2025-26 is increased by $191,900 to increase authorized FTE positions by 1.42 positions for the Office of Legal Counsel. In the schedule under s. 20.005 (3) for the appropriation to the department of children and families under s. 20.437 (1) (a), the dollar amount for fiscal year 2026-27 is increased by $255,900 to increase authorized FTE positions by 1.42 positions for the Office of Legal Counsel.

AB50-ASA2-AA8,158,13 (2) Office of legal counsel; federal funding. In the schedule under s. 20.005 (3) for the appropriation to the department of children and families under s. 20.437 (1) (md), the dollar amount for fiscal year 2025-26 is increased by $78,400 to increase authorized FTE positions by 0.58 positions for the Office of Legal Counsel. In the schedule under s. 20.005 (3) for the appropriation to the department of children and families under s. 20.437 (1) (md), the dollar amount for fiscal year 2026-27 is increased by $104,500 to increase authorized FTE positions by 0.58 positions for the Office of Legal Counsel.”.

AB50-ASA2-AA8,158,14 50. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,158,15 “Section 9206. Fiscal changes; Children and Families.

AB50-ASA2-AA8,158,23 (1) Direct child care services; Wisconsin Shares services reestimate. In the schedule under s. 20.005 (3) for the appropriation to the department of children and families under s. 20.437 (1) (md), the dollar amount for fiscal year 2025-26 is decreased by $25,291,400 to reflect estimates of the cost of subsidies under current law. In the schedule under s. 20.005 (3) for the appropriation to the department of children and families under s. 20.437 (1) (md), the dollar amount for fiscal year 2026-27 is decreased by $25,290,600 to reflect estimates of the cost of subsidies under current law.”.

AB50-ASA2-AA8,158,24 51. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,159,1 “Section 9206. Fiscal changes; Children and Families.