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Analysis by the Legislative Reference Bureau
This bill requires that the Department of Health Services reimburse
ambulance service providers for a set of two epinephrine auto-injectors or a set of two
draw-up epinephrine kits for each ambulance operating in the state. Under the bill,
an ambulance service provider means an ambulance service provider that is a public
agency, volunteer fire department, or nonprofit corporation. The bill also requires
that, on an ongoing basis, DHS must, upon request, reimburse ambulance service
providers for replacement sets of epinephrine auto-injectors or draw-up
epinephrine kits. DHS may only reimburse ambulance service providers for
epinephrine if each ambulance for which the ambulance service provider is
reimbursed is staffed with an emergency medical service provider who is qualified
to administer the epinephrine. The bill provides additional funding to the
Department of Public Instruction for aids for special education and to the University
of Wisconsin System and technical college system for purposes of maintaining
compliance with maintenance of effort requirements of the federal Consolidated
Appropriations Act and the federal American Rescue Plan Act.

Also, for drug products prescribed to counteract anaphylaxis, this bill allows,
if certain conditions are met, a pharmacist to substitute a drug product with another
drug product that would, in the opinion of the pharmacist, have a substantially
equivalent therapeutic effect even though the substitute drug product is not a drug
product equivalent. The bill also provides that a pharmacist who dispenses a drug
product for a patient in a hospital may, for a drug product prescribed to counteract
anaphylaxis, under the same conditions applicable for drug product equivalents
under current law, substitute a drug product with another drug product that would,
in the opinion of the pharmacist, have a substantially equivalent therapeutic effect
even though the substitute drug product is not a drug product equivalent. Current
law defines a “drug product equivalent” as a drug product that is designated the
therapeutic equivalent of another drug product by the federal Food and Drug
Administration as set forth in the latest edition of the supplement to the federal Food
and Drug Administration's Approved Drug Products with Therapeutic Equivalence
Evaluations
, commonly known as the Orange Book. As with substitution of drug
product equivalents under current law, the therapeutic substitutions allowed under
the bill do not apply to biological products.
For further information see the state and local 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:
AB740,1 1Section 1 . 20.435 (1) (ck) of the statutes is created to read:
AB740,2,42 20.435 (1) (ck) Epinephrine for ambulances. A sum sufficient for the
3department of health services to reimburse ambulance service providers for
4epinephrine under s. 256.158.
AB740,2 5Section 2. 256.158 of the statutes is created to read:
AB740,2,6 6256.158 Epinephrine for ambulances. (1) In this section:
AB740,2,87 (a) “Ambulance service provider” means an ambulance service provider that is
8a public agency, volunteer fire department, or nonprofit corporation.
AB740,2,109 (b) “Draw-up epinephrine” means epinephrine that is administered
10intramuscularly using a needle and syringe and drawn up from a vial or ampule.
AB740,2,1211 (c) “Draw-up epinephrine kit” means a single-use vial or ampule of draw-up
12epinephrine and a syringe for administration to a patient.
AB740,3,11
1(2) From the appropriation under s. 20.435 (1) (ck), the department shall
2reimburse ambulance service providers for a set of 2 epinephrine auto-injectors or
3a set of 2 draw-up epinephrine kits for each ambulance operating in the state. On
4an ongoing basis, the department shall, upon request from an ambulance service
5provider, reimburse the ambulance service provider for a replacement set of 2
6epinephrine auto-injectors or a set of 2 draw-up epinephrine kits. The department
7shall allow the ambulance service provider to choose between epinephrine
8auto-injectors and draw-up epinephrine kits. The department may not reimburse
9an ambulance service provider for epinephrine unless each ambulance for which the
10ambulance service provider is reimbursed is staffed with an emergency medical
11services practitioner who is qualified to administer the provided epinephrine.
AB740,3 12Section 3. 450.13 (title) of the statutes is amended to read:
AB740,3,15 13450.13 (title) Using drug product equivalent in dispensing
14prescriptions
; therapeutic exchange for drug products prescribed to
15counteract anaphylaxis
.
AB740,4 16Section 4. 450.13 (5n) of the statutes is created to read:
AB740,3,2217 450.13 (5n) Therapeutic interchange for drugs counteracting anaphylaxis.
18(a) Notwithstanding subs. (1s) to (4), for a drug product prescribed to counteract
19anaphylaxis, a pharmacist may substitute a drug product with another drug product
20that would, in the opinion of the pharmacist, have a substantially equivalent
21therapeutic effect even though the substitute drug product is not a drug product
22equivalent, provided all of the following conditions are met:
AB740,4,223 1. A prescribing practitioner has not indicated, by writing on the face of the
24prescription order or, with respect to a prescription order transmitted electronically,
25by designating in electronic format that a substitution of the drug product prescribed

1may not be made under this subsection. If such indication is made, the pharmacist
2shall dispense the prescription with the specific drug product prescribed.
AB740,4,53 2. The drug product substitution is intended to ensure formulary compliance
4with the consumer's health insurance plan or, in the case of a consumer without
5insurance, to lower the cost to the patient while maintaining safety.
AB740,4,86 3. The consumer opts in to the drug product substitution, and the pharmacist
7clearly informs the consumer of the differences in the drug products and specifies
8that the consumer may refuse the substitution.
AB740,4,129 (b) If a pharmacist substitutes a drug product prescribed to counteract
10anaphylaxis under this subsection, the pharmacist must ensure that the prescriber's
11directions and quantity are modified to allow for equivalent dispensing to what was
12originally prescribed.
AB740,4,1513 (c) Within 5 business days after the dispensing of a drug product substitute
14under this subsection, the dispensing pharmacist or the pharmacist's designee shall
15do one of the following:
AB740,4,2116 1. Make an entry of the specific drug product provided to the patient, including
17the name of the product and the manufacturer. Entry into an electronic records
18system as described in this paragraph is presumed to provide notice to the
19prescribing practitioner. The communication shall be conveyed by making an entry
20that is electronically accessible to the prescribing practitioner through one of the
21following:
AB740,4,2222 a. An interoperable electronic medical records system.
AB740,4,2323 b. An electronic prescribing technology.
AB740,4,2424 c. A pharmacist benefit management system.
AB740,4,2525 d. A pharmacy record.
AB740,5,6
12. If a pharmacist is unable to make an entry as provided in subd. 1.,
2communicate the drug product substitute dispensed to the prescribing practitioner
3using facsimile, telephone, electronic transmission, or another prevailing means,
4except that communication under this paragraph is not required if a refill of the drug
5product is not changed from the product dispensed on the prior filling of the
6prescription.
AB740,5,167 (d) Notwithstanding pars. (a) to (c), a pharmacist who dispenses a drug product
8prescribed for a patient in a hospital may, for a drug product prescribed to counteract
9anaphylaxis, substitute a drug product with another drug product that would, in the
10opinion of the pharmacist, have a substantially equivalent therapeutic effect even
11though the substitute drug product is not a drug product equivalent, if the
12pharmacist dispenses the drug product substitute in accordance with written
13guidelines or procedures previously established by a pharmacy and therapeutics
14committee of the hospital and approved by the hospital's medical staff and use of the
15drug product substitute has been approved for a patient during the period of the
16patient's stay within the hospital by any of the following:
AB740,5,1717 1. The patient's individual physician.
AB740,5,2018 2. The patient's advanced practice nurse prescriber, if the advanced practice
19nurse prescriber has entered into a written agreement to collaborate with a
20physician.
AB740,5,2121 3. The patient's physician assistant.
AB740,5 22Section 5. Fiscal changes.
AB740,6,323 (1) Special education aid; epinephrine for ambulances. In the schedule under
24s. 20.005 (3) for the appropriation to the department of public instruction under s.
2520.255 (2) (b), the dollar amount for fiscal year 2021-22 is increased by $125,000 for

1the purpose for which the appropriation is made and the dollar amount for fiscal year
22022-23 is increased by $125,000 for the purpose for which the appropriation is
3made.
AB740,6,94 (2) UW System, general program operation; epinephrine for ambulances. In
5the schedule under s. 20.005 (3) for the appropriation to the board of regents of the
6University of Wisconsin System under s. 20.285 (1) (a), the dollar amount for fiscal
7year 2021-22 is increased by $25,500 for the purpose for which the appropriation is
8made and the dollar amount for fiscal year 2022-23 is increased by $25,500 for the
9purpose for which the appropriation is made.
AB740,6,1510 (3) State aids for technical colleges; epinephrine for ambulances. In the
11schedule under s. 20.005 (3) for the appropriation to the technical college system
12board under s. 20.292 (1) (d), the dollar amount for fiscal year 2021-22 is increased
13by $4,500 for the purpose for which the appropriation is made and the dollar amount
14for fiscal year 2022-23 is increased by $4,500 for the purpose for which the
15appropriation is made.
AB740,6,1616 (End)
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