Amendment SA15-SSA2-SB45

2025 - 2026 LEGISLATURE

LRBb0686/1

EKL:cdc&emw

SENATE AMENDMENT 15, TO SENATE SUBSTITUTE AMENDMENT 2, TO SENATE BILL 45

July 2, 2025 - Offered by Senators Hesselbein, Smith, Spreitzer, Drake, L. Johnson, Roys, Carpenter, Dassler-Alfheim, Habush Sinykin, Keyeski, Larson, Pfaff, Ratcliff and Wall.

SB45-SSA2-SA15,1,1 At the locations indicated, amend the substitute amendment as follows:

SB45-SSA2-SA15,1,2 1. At the appropriate places, insert all of the following:

SB45-SSA2-SA15,1,3 “Section 1. 609.83 of the statutes is amended to read:

SB45-SSA2-SA15,1,6 609.83 Coverage of drugs and devices. Limited service health organizations, preferred provider plans, and defined network plans are subject to ss. 632.853, 632.861, and 632.895 (6) (b), (16t), and (16v).

SB45-SSA2-SA15,2 Section 2. 632.895 (6) (title) of the statutes is amended to read:

SB45-SSA2-SA15,1,9 632.895 (6) (title) Equipment and supplies for treatment of diabetes; insulin.

SB45-SSA2-SA15,3 Section 3. 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and amended to read:

SB45-SSA2-SA15,2,11 632.895 (6) (a) Every disability insurance policy which that provides coverage of expenses incurred for treatment of diabetes shall provide coverage for expenses incurred by the installation and use of an insulin infusion pump, coverage for all other equipment and supplies, including insulin or any other prescription medication, used in the treatment of diabetes, and coverage of diabetic self- management education programs. Coverage Except as provided in par. (b), coverage required under this subsection shall be subject to the same exclusions, limitations, deductibles, and coinsurance provisions of the policy as other covered expenses, except that insulin infusion pump coverage may be limited to the purchase of one pump per year and the insurer may require the insured to use a pump for 30 days before purchase.

SB45-SSA2-SA15,4 Section 4. 632.895 (6) (b) of the statutes is created to read:

SB45-SSA2-SA15,2,13 632.895 (6) (b) 1. In this paragraph:

SB45-SSA2-SA15,2,16 a. “Cost sharing” means the total of any deductible, copayment, or coinsurance amounts imposed on a person covered under a disability insurance policy or self-insured health plan.

SB45-SSA2-SA15,2,17 b. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).

SB45-SSA2-SA15,2,20 2. Every disability insurance policy and self-insured health plan that covers insulin and imposes cost sharing on prescription drugs may not impose cost sharing on insulin in an amount that exceeds $35 for a one-month supply of insulin.

SB45-SSA2-SA15,3,2 3. Nothing in this paragraph prohibits a disability insurance policy or self- insured health plan from imposing cost sharing on insulin in an amount less than the amount specified under subd. 2. Nothing in this paragraph requires a disability insurance policy or self-insured health plan to impose any cost sharing on insulin.

SB45-SSA2-SA15,9423 Section 9423. Effective dates; Insurance.

SB45-SSA2-SA15,3,7 (1) Cost-sharing cap on insulin. The treatment of ss. 609.83 and 632.895 (6) (title), the renumbering and amendment of s. 632.895 (6), and the creation of s. 632.895 (6) (b) take effect on the first day of the 4th month beginning after publication.”.

SB45-SSA2-SA15,3,8 (end)