This is the preview version of the Wisconsin State Legislature site.
Please see http://docs.legis.wisconsin.gov for the production version.
8. The relative financial impacts to health, medical, or social services costs that
can be quantified and compared to baseline effects of existing therapeutic
alternatives.
9. The average patient copay or other cost sharing for the drug.
If the board determines that a prescription drug will lead to an affordability
challenge, the bill directs the board to establish an upper payment limit for that drug
that applies to all purchases and payor reimbursements of the drug dispensed or
administered to individuals in Wisconsin. In establishing the upper payment limit,
the board must consider the cost of administering the drug, the cost of delivering it
to consumers, and other relevant administrative costs. For certain drugs, the board
must solicit information from the manufacturer regarding the price increase and, if
the board determines 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 must establish an upper payment limit equal to the
drug's cost prior to the price increase.

For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB544,1 1Section 1 . 15.07 (3) (bm) 7. of the statutes is created to read:
AB544,3,32 15.07 (3) (bm) 7. The prescription drug affordability review board shall meet
3at least 4 times each year.
AB544,2 4Section 2 . 15.735 of the statutes is created to read:
AB544,3,7 515.735 Same; attached board. (1) There is created a prescription drug
6affordability review board attached to the office of the commissioner of insurance
7under s. 15.03. The board shall consist of the following members:
AB544,3,88 (a) The commissioner of insurance or his or her designee.
AB544,3,129 (b) Two members appointed for 4-year terms who represent the
10pharmaceutical drug industry, including pharmaceutical drug manufacturers and
11wholesalers. At least one of the members appointed under this paragraph shall be
12a licensed pharmacist.
AB544,3,1413 (c) Two members appointed for 4-year terms who represent the health
14insurance industry, including insurers and pharmacy benefit managers.
AB544,3,1715 (d) Two members appointed for 4-year terms who represent the health care
16industry, including hospitals, physicians, pharmacies, and pharmacists. At least one
17of the members appointed under this paragraph shall be a licensed practitioner.
AB544,3,1918 (e) Two members appointed for 4-year terms who represent the interests of the
19public.
AB544,4,3
1(2) A member appointed under sub. (1) may not be an employee of, a board
2member of, or a consultant to a drug manufacturer or trade association for drug
3manufacturers.
AB544,4,8 4(3) Any conflict of interest, including any financial or personal association, that
5has the potential to bias or has the appearance of biasing an individual's decision in
6matters related to the board or the conduct of the board's activities shall be
7considered and disclosed when appointing that individual to the board under sub.
8(1).
AB544,3 9Section 3 . Subchapter VI (title) of chapter 601 [precedes 601.78] of the
10statutes is created to read:
AB544,4,1111 CHAPTER 601
AB544,4,1312 SUBCHAPTER VI
13 Prescription drug
AB544,4,1414 affordability review board
AB544,4,15 15601.78 Definitions. In this subchapter:
AB544,4,17 16(1) “Biologic” means a drug that is produced or distributed in accordance with
17a biologics license application approved under 21 CFR 601.20.
AB544,4,19 18(2) “Biosimilar” means a drug that is produced or distributed in accordance
19with a biologics license application approved under 42 USC 262 (k) (3).
AB544,4,21 20(3) “Board” means the prescription drug affordability review board established
21under s. 15.735 (1).
AB544,4,24 22(4) “Brand name drug” means a drug that is produced or distributed in
23accordance with an original new drug application approved under 21 USC 355 (c),
24other than an authorized generic drug, as defined in 42 CFR 447.502.
AB544,5,2
1(5) “Drug product” means a brand name drug, a generic drug, a biologic, a
2biosimilar, or an over-the-counter drug.
AB544,5,6 3(6) “Financial benefit” includes an honoraria, fee, stock, the value of the stock
4holdings of a member of the board or any immediate family member, as defined in
5s. 97.605 (4) (a) 2., and any direct financial benefit deriving from the finding of a
6review conducted under s. 601.79.
AB544,5,7 7(7) “Generic drug” means any of the following:
AB544,5,98 (a) A retail drug that is marketed or distributed in accordance with an
9abbreviated new drug application approved under 21 USC 355 (j).
AB544,5,1010(b) An authorized generic drug, as defined in 42 CFR 447.502.
AB544,5,1211 (c) A drug that entered the market prior to 1962 and was not originally
12marketed under a new drug application.
AB544,5,13 13(8) “Manufacturer” means an entity that does all of the following:
AB544,5,1614 (a) Engages in the manufacture of a drug product or enters into a lease with
15another manufacturer to market and distribute a prescription drug product under
16the entity's own name.
AB544,5,1817 (b) Sets or changes the wholesale acquisition cost of the drug product or
18prescription drug product described in par. (a).
AB544,5,20 19(9) “Over-the-counter drug” means a drug intended for human use that does
20not require a prescription and meets the requirements of 21CFR parts 328 to 364.
AB544,5,21 21(10) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
AB544,5,23 22(11) “Prescription drug product” means a brand name drug, a generic drug, a
23biologic, or a biosimilar.
AB544,6,3 24601.785 Prescription drug affordability review board. (1) Mission. The
25purpose of the board is to protect state residents, the state, local governments, health

1plans, health care providers, pharmacies licensed in this state, and other
2stakeholders of the health care system in this state from the high costs of prescription
3drug products.
AB544,6,4 4(2) Powers and duties. (a) The board shall do all of the following:
AB544,6,75 1. Meet in open session at least 4 times per year to review prescription drug
6product pricing information, except that the chair may cancel or postpone a meeting
7if there is no business to transact.
AB544,6,98 2. To the extent practicable, access and assess pricing information for
9prescription drug products by doing all of the following:
AB544,6,1210 a. Accessing and assessing information from other states by entering into
11memoranda of understanding with other states to which manufacturers report
12pricing information.
AB544,6,1313 b. Assessing spending for specific prescription drug products in this state.
AB544,6,1414 c. Accessing other available pricing information.
AB544,6,1515 (b) The board may:
AB544,6,1616 1. Promulgate rules for the administration of this subchapter.
AB544,6,2117 2. Enter into a contract with an independent 3rd party for any service
18necessary to carry out the powers and duties of the board. Unless written permission
19is granted by the board, any person with whom the board contracts may not release,
20publish, or otherwise use any information to which the person has access under the
21contract.
AB544,6,25 22(3) Meeting requirements. (a) Pursuant to s. 19.84, the board shall provide
23public notice of each board meeting at least 2 weeks prior to the meeting and shall
24make the materials for each meeting publicly available at least one week prior to the
25meeting.
AB544,7,3
1(b) Notwithstanding s. 19.84 (2), the board shall provide an opportunity for
2public comment at each open meeting and shall provide the public with the
3opportunity to provide written comments on pending decisions of the board.
AB544,7,64 (c) Notwithstanding subch. V of ch. 19, any portion of a meeting of the board
5concerning proprietary data and information shall be conducted in closed session
6and shall in all respects remain confidential.
AB544,7,87 (d) The board may allow expert testimony at any meeting, including when the
8board meets in closed session.
AB544,7,12 9(4) Conflicts of interest. (a) A member of the board shall recuse himself or
10herself from a decision by the board relating to a prescription drug product if the
11member or an immediate family member, as defined in s. 97.605 (4) (a) 2., has
12received or could receive any of the following:
AB544,7,1413 1. A direct financial benefit deriving from a determination, or a finding of a
14study or review, by the board relating to the prescription drug product.
AB544,7,1715 2. A financial benefit in excess of $5,000 in a calendar year from any person who
16owns, manufactures, or provides a prescription drug product to be studied or
17reviewed by the board.
AB544,7,2118 (b) A conflict of interest shall be disclosed by the board when hiring board staff,
19by the appointing authority when appointing members to the board, and by the board
20when a member of the board is recused from any final decision resulting from a
21review of a prescription drug product.
AB544,7,2422 (c) A conflict of interest shall be disclosed no later than 5 days after the conflict
23is identified, except that, if the conflict is identified within 5 days of an open meeting
24of the board, the conflict shall be disclosed prior to the meeting.
AB544,8,5
1(d) The board shall disclose a conflict of interest under this subsection on the
2board's Internet site unless the chair of the board recuses the member from a final
3decision resulting from a review of the prescription drug product. The disclosure
4shall include the type, nature, and magnitude of the interests of the member
5involved.
AB544,8,86 (e) A member of the board or a 3rd-party contractor may not accept any gift or
7donation of services or property that indicates a potential conflict of interest or has
8the appearance of biasing the work of the board.
AB544,8,10 9601.79 Drug cost affordability review. (1) Identification of drugs. The
10board shall identify prescription drug products that are any of the following:
AB544,8,1511 (a) A brand name drug or biologic that, as adjusted annually to reflect
12adjustments to the U.S. consumer price index for all urban consumers, U.S. city
13average, as determined by the U.S. department of labor, has a launch wholesale
14acquisition cost of at least $30,000 per year or course of treatment or whose wholesale
15acquisition cost increased at least $3,000 during a 12–month period.
AB544,8,1816 (b) A biosimilar drug that has a launch wholesale acquisition cost that is not
17at least 15 percent lower than the referenced brand biologic at the time the biosimilar
18is launched.
AB544,8,2219 (c) A generic drug that has a wholesale acquisition cost, as adjusted annually
20to reflect adjustments to the U.S. consumer price index for all urban consumers, U.S.
21city average, as determined by the U.S. department of labor, that meets all of the
22following conditions:
AB544,9,323 1. Is at least $100 for a supply lasting a patient for a period of 30 consecutive
24days based on the recommended dosage approved for labeling by the U.S. food and
25drug administration, a supply lasting a patient for fewer than 30 days based on the

1recommended dosage approved for labeling by the federal food and drug
2administration, or one unit of the drug if the labeling approved by the federal food
3and drug administration does not recommend a finite dosage.
AB544,9,64 2. Increased by at least 200 percent during the preceding 12–month period, as
5determined by the difference between the resulting wholesale acquisition cost and
6the average of the wholesale acquisition cost reported over the preceding 12 months.
AB544,9,97 (d) Other prescription drug products, including drugs to address public health
8emergencies, that may create affordability challenges for the health care system and
9patients in this state.
AB544,9,14 10(2) Affordability review. (a) After identifying prescription drug products
11under sub. (1), the board shall determine whether to conduct an affordability review
12for each identified prescription drug product by seeking stakeholder input about the
13prescription drug product and considering the average patient cost share of the
14prescription drug product.
AB544,9,2015 (b) The information to conduct an affordability review under par. (a) may
16include any document and research related to the manufacturer's selection of the
17introductory price or price increase of the prescription drug product, including life
18cycle management, net average price in this state, market competition and context,
19projected revenue, and the estimated value or cost–effectiveness of the prescription
20drug product.
AB544,9,2221 (c) The failure of a manufacturer to provide the board with information for an
22affordability review does not affect the authority of the board to conduct the review.
AB544,9,25 23(3) Affordability challenge. When conducting an affordability review of a
24prescription drug product, the board shall determine whether use of the prescription
25drug product that is fully consistent with the labeling approved by the federal food

1and drug administration or standard medical practice has led or will lead to an
2affordability challenge for the health care system in this state, including high
3out–of–pocket costs for patients. To the extent practicable, in determining whether
4a prescription drug product has led or will lead to an affordability challenge, the
5board shall consider all of the following factors:
AB544,10,76 (a) The wholesale acquisition cost for the prescription drug product sold in this
7state.
AB544,10,118 (b) The average monetary price concession, discount, or rebate the
9manufacturer provides, or is expected to provide, to health plans in this state as
10reported by manufacturers and health plans, expressed as a percent of the wholesale
11acquisition cost for the prescription drug product under review.
AB544,10,1512 (c) The total amount of the price concessions, discounts, and rebates the
13manufacturer provides to each pharmacy benefit manager for the prescription drug
14product under review, as reported by the manufacturer and pharmacy benefit
15manager and expressed as a percent of the wholesale acquisition costs.
AB544,10,1616 (d) The price at which therapeutic alternatives have been sold in this state.
AB544,10,1917 (e) The average monetary concession, discount, or rebate the manufacturer
18provides or is expected to provide to health plan payors and pharmacy benefit
19managers in this state for therapeutic alternatives.
AB544,10,2220 (f) The costs to health plans based on patient access consistent with labeled
21indications by the federal food and drug administration and recognized standard
22medical practice.
AB544,10,2423 (g) The impact on patient access resulting from the cost of the prescription drug
24product relative to insurance benefit design.
AB544,11,2
1(h) The current or expected dollar value of drug–specific patient access
2programs that are supported by the manufacturer.
AB544,11,53 (i) The relative financial impacts to health, medical, or social services costs that
4can be quantified and compared to baseline effects of existing therapeutic
5alternatives.
AB544,11,76 (j) The average patient copay or other cost sharing for the prescription drug
7product in the state.
AB544,11,88 (k) Any information a manufacturer chooses to provide.
AB544,11,99 (L) Any other factors as determined by the board by rule.
AB544,11,13 10(4) Upper payment limit. (a) If the board determines under sub. (3) that use
11of a prescription drug product has led or will lead to an affordability challenge, the
12board shall establish an upper payment limit for the prescription drug product after
13considering all of the following:
AB544,11,1414 1. The cost of administering the drug.
AB544,11,1515 2. The cost of delivering the drug to consumers.
AB544,11,1616 3. Other relevant administrative costs related to the drug.
AB544,11,2217 (b) For a prescription drug product identified in sub. (1) (d), the board shall
18solicit information from the manufacturer regarding the price increase. To the
19extent that the price increase is not a result of the need for increased manufacturing
20capacity or other effort to improve patient access during a public health emergency,
21the board shall establish an upper payment limit under par. (a) that is equal to the
22cost to consumers prior to the price increase.
AB544,12,223 (c) 1. The upper payment limit established under this subsection shall apply
24to all purchases and payor reimbursements of the prescription drug product

1dispensed or administered to individuals in this state in person, by mail, or by other
2means.
AB544,12,133 2. Notwithstanding subd. 1., while state-sponsored and state-regulated
4health plans and health programs shall limit drug reimbursements and drug
5payment to no more than the upper payment limit established under this subsection,
6a plan subject to the Employee Retirement Income Security Act of 1974 or Part D of
7Medicare under 42 USC 1395w-101 et seq. may choose to reimburse more than the
8upper payment limit. A provider who dispenses and administers a prescription drug
9product in this state to an individual in this state may not bill a payor more than the
10upper payment limit to the patient regardless of whether a plan subject to the
11Employee Retirement Income Security Act of 1974 or Part D of Medicare under 42
12USC 1395w-101
et seq. chooses to reimburse the provider above the upper payment
13limit.
Loading...
Loading...