SB50: Bill Text

SB50,16 Section 16. 601.57 of the statutes is created to read:

SB50,11,15 601.57 Pharmacy services administrative organizations. (1) Definitions. In this section:

SB50,11,16 (a) “Administrative service” means any of the following:

SB50,11,17 1. Assisting with claims.

SB50,11,18 2. Assisting with audits.

SB50,11,19 3. Providing centralized payment.

SB50,11,20 4. Performing certification in a specialized care program.

SB50,11,21 5. Providing compliance support.

SB50,11,22 6. Setting flat fees for generic drugs.

SB50,11,23 7. Assisting with store layout.

SB50,12,1 8. Managing inventory.

SB50,12,2 9. Providing marketing support.

SB50,12,4 10. Providing management and analysis of payment and drug dispensing data.

SB50,12,5 11. Providing resources for retail cash cards.

SB50,12,8 (b) “Independent pharmacy” means a pharmacy operating in this state that is licensed under s. 450.06 or 450.065 and is under common ownership with no more than 2 other pharmacies.

SB50,12,9 (c) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

SB50,12,11 (d) “Pharmacy services administrative organization” means an entity operating in this state that does all of the following:

SB50,12,13 1. Contracts with an independent pharmacy to conduct business on the independent pharmacy’s behalf with a 3rd-party payer.

SB50,12,16 2. Provides at least one administrative service to an independent pharmacy and negotiates and enters into a contract with a 3rd-party payer or pharmacy benefit manager on behalf of the independent pharmacy.

SB50,12,19 (e) “Third-party payer” means an entity, including a plan sponsor, health maintenance organization, or insurer, operating in this state that pays or insures health, medical, or prescription drug expenses on behalf of beneficiaries.

SB50,13,2 (2) Licensure. (a) No person may operate as a pharmacy services administrative organization in this state without being licensed by the commissioner as a pharmacy services administrative organization under this section. In order to obtain or renew a license, the person shall apply to the commissioner in the form and manner prescribed by the commissioner. The application shall include all of the following:

SB50,13,4 1. The name, address, telephone number, and federal employer identification number of the applicant.

SB50,13,6 2. The name, business address, and telephone number of a contact person for the applicant.

SB50,13,7 3. The fee under s. 601.31 (1) (nw).

SB50,13,8 4. Evidence of financial responsibility of at least $1,000,000.

SB50,13,9 5. Any other information required by the commissioner by rule.

SB50,13,11 (b) The term of a license issued under par. (a) shall be 2 years from the date of issuance.

SB50,13,15 (3) Disclosure to the commissioner. (a) A pharmacy services administrative organization licensed under sub. (2) shall disclose to the commissioner the extent of any ownership or control of the pharmacy services administrative organization by an entity that does any of the following:

SB50,13,16 1. Provides pharmacy services.

SB50,13,17 2. Provides prescription drug or device services.

SB50,13,19 3. Manufactures, sells, or distributes prescription drugs, biologicals, or medical devices.

SB50,13,22 (b) A pharmacy services administrative organization licensed under sub. (2) shall notify the commissioner in writing within 5 days of any material change in its ownership or control relating to an entity described in par. (a).

SB50,14,2 (4) Rules. The commissioner may promulgate rules to implement this section.

SB50,17 Section 17. 601.575 of the statutes is created to read:

SB50,14,9 601.575 Prescription drug importation program. (1) Importation program requirements. The commissioner, in consultation with persons interested in the sale and pricing of prescription drugs and appropriate officials and agencies of the federal government, shall design and implement a prescription drug importation program for the benefit of residents of this state, that generates savings for residents, and that satisfies all of the following:

SB50,14,12 (a) The commissioner shall designate a state agency to become a licensed wholesale distributor or to contract with a licensed wholesale distributor and shall seek federal certification and approval to import prescription drugs.

SB50,14,14 (b) The program shall comply with relevant requirements of 21 USC 384, including safety and cost savings requirements.

SB50,14,16 (c) The program shall import prescription drugs from Canadian suppliers regulated under any appropriate Canadian or provincial laws.

SB50,14,18 (d) The program shall have a process to sample the purity, chemical composition, and potency of imported prescription drugs.

SB50,14,22 (e) The program shall import only those prescription drugs for which importation creates substantial savings for residents of this state and only those prescription drugs that are not brand-name drugs and that have fewer than 4 competitor prescription drugs in the United States.

SB50,15,2 (f) The commissioner shall ensure that prescription drugs imported under the program are not distributed, dispensed, or sold outside of this state.

SB50,15,3 (g) The program shall ensure all of the following:

SB50,15,5 1. Participation by any pharmacy or health care provider in the program is voluntary.

SB50,15,7 2. Any pharmacy or health care provider participating in the program has the appropriate license or other credential in this state.

SB50,15,10 3. Any pharmacy or health care provider participating in the program charges a consumer or health plan the actual acquisition cost of the imported prescription drug that is dispensed.

SB50,15,14 (h) The program shall ensure that a payment by a health plan or health insurance policy for a prescription drug imported under the program reimburses no more than the actual acquisition cost of the imported prescription drug that is dispensed.

SB50,15,16 (i) The program shall ensure that any health plan or health insurance policy participating in the program does all of the following:

SB50,15,18 1. Maintains a formulary and claims payment system with current information on prescription drugs imported under the program.

SB50,15,21 2. Bases cost-sharing amounts for participants or insureds under the plan or policy on no more than the actual acquisition cost of the prescription drug imported under the program that is dispensed to the participant or insured.

SB50,16,2 3. Demonstrates to the commissioner or a state agency designated by the commissioner how premiums under the plan or policy are affected by savings on prescription drugs imported under the program.

SB50,16,5 (j) Any wholesale distributor importing prescription drugs under the program shall limit its profit margin to the amount established by the commissioner or a state agency designated by the commissioner.

SB50,16,7 (k) The program may not import any generic prescription drug that would violate federal patent laws on branded products in the United States.

SB50,16,12 (L) The program shall comply with tracking and tracing requirements of 21 USC 360eee and 360eee-1, to the extent practical and feasible, before the prescription drug to be imported comes into the possession of this state’s wholesale distributor and fully after the prescription drug to be imported is in the possession of this state’s wholesale distributor.

SB50,16,14 (m) The program shall establish a fee or other mechanism to finance the program that does not jeopardize significant savings to residents of this state.

SB50,16,15 (n) The program shall have an audit function that ensures all of the following:

SB50,16,17 1. The commissioner has a sound methodology to determine the most cost- effective prescription drugs to include in the program.

SB50,16,19 2. The commissioner has a process in place to select Canadian suppliers that are high quality, high performing, and in full compliance with Canadian laws.

SB50,16,21 3. Prescription drugs imported under the program are pure, unadulterated, potent, and safe.

SB50,16,22 4. The program is complying with the requirements of this subsection.

SB50,17,2 5. The program is adequately financed to support administrative functions of the program while generating significant cost savings to residents of this state.

SB50,17,4 6. The program does not put residents of this state at a higher risk than if the program did not exist.

SB50,17,6 7. The program provides and is projected to continue to provide substantial cost savings to residents of this state.

SB50,17,9 (2) Anticompetitive behavior. The commissioner, in consultation with the attorney general, shall identify the potential for and monitor anticompetitive behavior in industries affected by a prescription drug importation program.

SB50,17,19 (3) Approval of program design; certification. No later than the first day of the 7th month beginning after the effective date of this subsection .... [LRB inserts date], the commissioner shall submit to the joint committee on finance a report that includes the design of the prescription drug importation program in accordance with this section. The commissioner may not submit the proposed program to the federal department of health and human services unless the joint committee on finance approves the proposed program. Within 14 days of the date of approval by the joint committee on finance of the proposed program, the commissioner shall submit to the federal department of health and human services a request for certification of the approved program.

SB50,18,4 (4) Implementation of certified program. After the federal department of health and human services certifies the prescription drug importation program submitted under sub. (3), the commissioner shall begin implementation of the program, and the program shall be fully operational by 180 days after the date of certification by the federal department of health and human services. The commissioner shall do all of the following to implement the program to the extent the action is in accordance with other state laws and the certification by the federal department of health and human services:

SB50,18,7 (a) Become a licensed wholesale distributor, designate another state agency to become a licensed wholesale distributor, or contract with a licensed wholesale distributor.

SB50,18,9 (b) Contract with one or more Canadian suppliers that meet the criteria in sub. (1) (c) and (n).

SB50,18,12 (c) Create an outreach and marketing plan to communicate with and provide information to health plans and health insurance policies, employers, pharmacies, health care providers, and residents of this state on participating in the program.

SB50,18,15 (d) Develop and implement a registration process for health plans and health insurance policies, pharmacies, and health care providers interested in participating in the program.

SB50,18,17 (e) Create a publicly accessible source for listing prices of prescription drugs imported under the program.

SB50,18,20 (f) Create, publicize, and implement a method of communication to promptly answer questions from and address the needs of persons affected by the implementation of the program before the program is fully operational.

SB50,18,22 (g) Establish the audit functions under sub. (1) (n) with a timeline to complete each audit function every 2 years.

SB50,19,2 (h) Conduct any other activities determined by the commissioner to be important to successful implementation of the program.

SB50,19,4 (5) Report. By January 1 and July 1 of each year, the commissioner shall submit to the joint committee on finance a report including all of the following:

SB50,19,6 (a) A list of prescription drugs included in the prescription drug importation program under this section.

SB50,19,9 (b) The number of pharmacies, health care providers, and health plans and health insurance policies participating in the prescription drug importation program under this section.

SB50,19,14 (c) The estimated amount of savings to residents of this state, health plans and health insurance policies, and employers resulting from the implementation of the prescription drug importation program under this section reported from the date of the previous report under this subsection and from the date the program was fully operational.

SB50,19,16 (d) Findings of any audit functions under sub. (1) (n) completed since the date of the previous report under this subsection.

SB50,19,18 (6) Rule making. The commissioner may promulgate any rules necessary to implement this section.

SB50,18 Section 18. Subchapter VI of chapter 601 [precedes 601.78] of the statutes is created to read:

SB50,19,21 CHAPTER 601

SB50,19,22 SUBCHAPTER VI

SB50,20,2 PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD

SB50,20,3 601.78 Definitions. In this subchapter:

SB50,20,5 (1) “Biologic” means a drug that is produced or distributed in accordance with a biologics license application approved under 21 CFR 601.20.

SB50,20,7 (2) “Biosimilar” means a drug that is produced or distributed in accordance with a biologics license application approved under 42 USC 262 (k) (3).

SB50,20,9 (3) “Board” means the prescription drug affordability review board established under s. 15.735 (1).

SB50,20,12 (4) “Brand name drug” means a drug that is produced or distributed in accordance with an original new drug application approved under 21 USC 355 (c), other than an authorized generic drug, as defined in 42 CFR 447.502.

SB50,20,14 (5) “Drug product” means a brand name drug, a generic drug, a biologic, a biosimilar, or an over-the-counter drug.