SB50: Bill Text

The bill requires that insulin manufacturers annually report to OCI certain information, including the number of individuals served and the cost of insulin dispensed under the programs and that OCI annually report to the governor and the legislature on the programs. The bill also directs OCI to conduct public outreach and develop an information sheet about the programs, conduct satisfaction surveys of individuals and pharmacies that participate in the programs, and report to the governor and the legislature on the surveys by July 1, 2028. Additionally, the bill requires that OCI develop a training program for health care navigators to assist individuals in accessing appropriate long-term insulin options and maintain a list of trained navigators.

The bill provides that a manufacturer that fails to comply with the bill’s provisions may be assessed a forfeiture of up to $200,000 per month of noncompliance, which increases to $400,000 per month if the manufacturer continues to be in noncompliance after six months and to $600,000 per month if the manufacturer continues to be in noncompliance after one year. The bill’s requirements do not apply to manufacturers with annual insulin sales revenue in Wisconsin of no more than $2,000,000 or to insulin that costs less than a specified dollar amount.

Prescription Drug Affordability Review Board

The bill creates a Prescription Drug Affordability Review Board, whose purpose is to protect Wisconsin residents and other stakeholders from the high costs of prescription drugs. The board consists of the commissioner of insurance and the following members, all of whom are appointed by the governor for four-year terms:

1. Two members who represent the pharmaceutical drug industry, at least one of whom is a licensed pharmacist.

2. Two members who represent the health insurance industry.

3. Two members who represent the health care industry, at least one of whom is a licensed practitioner.

4. Two members who represent the interests of the public.

The bill requires the board to meet in open session at least four times per year to review prescription drug pricing information. The board must provide at least two weeks’ public notice of each meeting, make the meeting’s materials publicly available at least one week prior to the meeting, and provide the opportunity for public comment. The bill imposes conflict of interest requirements for the board relating to recusal and public disclosure of certain conflicts. The bill directs the board to access and assess drug pricing information, to the extent practicable, by accessing and assessing information from other states, by assessing spending for the drug in Wisconsin, and by accessing other available pricing information.

Under the bill, the board must conduct drug cost affordability reviews. The board must identify prescription drugs whose launch wholesale acquisition cost exceeds specified thresholds, prescription drugs whose increase in wholesale acquisition cost exceeds specified thresholds, and other prescription drugs that may create affordability challenges for the health care system in Wisconsin. For each identified prescription drug, the board must determine whether to conduct an affordability review by seeking stakeholder input and considering the average patient cost share for the drug. During an affordability review, the board must determine whether use of the prescription drug 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 Wisconsin. In making this determination, the bill requires the board to consider a variety of factors, which include the following:

1. The drug’s wholesale acquisition cost.

2. The average monetary price concession, discount, or rebate the manufacturer provides, or is expected to provide, for the drug to health plans.

3. The total amount of price concessions, discounts, and rebates the manufacturer provides to each pharmacy benefit manager for the drug.

4. The price at which therapeutic alternatives have been sold and the average monetary concession, discount, or rebate the manufacturer provides, or is expected to provide, to health plan payors and pharmacy benefit managers for therapeutic alternatives.

5. The costs to health plans based on patient access consistent with federal labeled indications and recognized standard medical practice.

6. The impact on patient access resulting from the drug’s cost relative to insurance benefit design.

7. The current or expected dollar value of drug-specific patient access programs that are supported by the manufacturer.

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.

Further, this bill provides $500,000 in program revenue in fiscal year 2026–27 for onetime implementation costs associated with establishing an Office of Prescription Drug Affordability in OCI. The bill provides that the Office of Prescription Drug Affordability is responsible for prescription drug affordability programming within OCI and for overseeing the operations of the Prescription Drug Affordability Review Board. Additionally, the bill authorizes and funds for fiscal year 2026–27 16.0 positions for the Office of Prescription Drug Affordability.

Finally, the bill credits to the appropriation account for OCI’s general program operations all moneys received from the regulation of pharmacy benefit managers, pharmacy benefit management brokers, pharmacy benefit management consultants, pharmacy services administrative organizations, and pharmaceutical sales representatives.

This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.

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:

SB50,1 Section 1. 15.07 (3) (bm) 7. of the statutes is created to read:

SB50,2,3 15.07 (3) (bm) 7. The prescription drug affordability review board shall meet at least 4 times each year.

SB50,2 Section 2. 15.735 of the statutes is created to read:

SB50,2,7 15.735 Same; attached board. (1) There is created a prescription drug affordability review board attached to the office of the commissioner of insurance under s. 15.03. The board shall consist of the following members:

SB50,2,8 (a) The commissioner of insurance or his or her designee.

SB50,3,3 (b) Two members appointed for 4-year terms who represent the pharmaceutical drug industry, including pharmaceutical drug manufacturers and wholesalers. At least one of the members appointed under this paragraph shall be a pharmacist licensed in this state.

SB50,3,5 (c) Two members appointed for 4-year terms who represent the health insurance industry, including insurers and pharmacy benefit managers.

SB50,3,9 (d) Two members appointed for 4-year terms who represent the health care industry, including hospitals, physicians, pharmacies, and pharmacists. At least one of the members appointed under this paragraph shall be a licensed health care practitioner.

SB50,3,11 (e) Two members appointed for 4-year terms who represent the interests of the public.

SB50,3,14 (2) A member appointed under sub. (1), except for a member appointed under sub. (1) (b), may not be an employee of, a board member of, or a consultant to a drug manufacturer or trade association for drug manufacturers.

SB50,3,19 (3) Any conflict of interest, including any financial or personal association, that has the potential to bias or has the appearance of biasing an individual’s decision in matters related to the board or the conduct of the board’s activities shall be considered and disclosed when appointing that individual to the board under sub. (1).

SB50,3 Section 3. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated:

- See PDF for table

SB50,4 Section 4. 20.145 (1) (a) of the statutes is created to read:

SB50,4,7 20.145 (1) (a) State operations. The amounts in the schedule for general program operations.

SB50,5 Section 5. 20.145 (1) (g) 4. of the statutes is created to read:

SB50,4,12 20.145 (1) (g) 4. All moneys received from the regulation of pharmacy benefit managers, pharmacy benefit management brokers, pharmacy benefit management consultants, pharmacy services administrative organizations, and pharmaceutical sales representatives.

SB50,6 Section 6. 49.45 (18) (ac) of the statutes is amended to read:

SB50,5,2 49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag), any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the benefits under s. 49.46 (2) (a) and (b) under s. 49.471, shall pay up to the maximum amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided under s. 49.46 (2). The service provider shall collect the specified or allowable copayment, coinsurance, or deductible, unless the service provider determines that the cost of collecting the copayment, coinsurance, or deductible exceeds the amount to be collected. The department shall reduce payments to each provider by the amount of the specified or allowable copayment, coinsurance, or deductible. No provider may deny care or services because the recipient is unable to share costs, but an inability to share costs specified in this subsection does not relieve the recipient of liability for these costs.

SB50,7 Section 7. 49.45 (18) (ag) of the statutes is repealed.

SB50,8 Section 8. 49.45 (18) (b) 8. of the statutes is created to read:

SB50,5,5 49.45 (18) (b) 8. Prescription drugs.

SB50,9 Section 9. 255.056 (2g) of the statutes is created to read:

SB50,5,12 255.056 (2g) The department may partner with out-of-state drug repository programs. The department may authorize a medical facility or pharmacy that elects to participate in the drug repository program to receive drugs or supplies from out of state, and the department may authorize an out-of-state entity that participates in a partner out-of-state drug repository program to receive drugs or supplies from Wisconsin.

SB50,10 Section 10. 450.085 (3) of the statutes is created to read:

SB50,5,16 450.085 (3) An applicant for renewal of a license under s. 450.08 (2) (a) may count, for purposes of the continuing education requirement under sub. (1), up to 10 hours spent as a volunteer at a free and charitable clinic approved by the board.

SB50,11 Section 11. 601.31 (1) (nv) of the statutes is created to read:

SB50,5,19 601.31 (1) (nv) For issuing or renewing a license as a pharmaceutical representative under s. 601.56, an amount to be set by the commissioner by rule.

SB50,12 Section 12. 601.31 (1) (nw) of the statutes is created to read:

SB50,5,23 601.31 (1) (nw) For issuing or renewing a license as a pharmacy services administrative organization under s. 601.57, an amount to be set by the commissioner by rule.

SB50,13 Section 13. 601.41 (14) of the statutes is created to read:

SB50,6,7 601.41 (14) Value-based diabetes medication pilot project. The commissioner shall develop a pilot project to direct a pharmacy benefit manager, as defined in s. 632.865 (1) (c), and a pharmaceutical manufacturer to create a value- based, sole-source arrangement to reduce the costs of prescription medication used to treat diabetes. The commissioner may promulgate rules to implement this subsection.

SB50,14 Section 14. 601.415 (14) of the statutes is created to read:

SB50,6,14 601.415 (14) Patient pharmacy benefits tool. (a) From the appropriation under s. 20.145 (1) (a), beginning in the 2026-27 fiscal year, the office shall award grants in a total amount of up to $500,000 each fiscal year to health care providers to develop and implement a tool for prescribers to disclose the cost of prescription drugs for patients. The tool must be usable by physicians and other prescribers to determine the cost of prescription drugs for their patients.

SB50,6,17 (b) Any health care provider that receives a grant under par. (a) shall contribute matching funds equal to at least 50 percent of the grant amount awarded.

SB50,15 Section 15. 601.56 of the statutes is created to read:

SB50,6,20 601.56 Pharmaceutical representatives. (1) Definitions. In this section:

SB50,6,23 (a) “Health care professional” means a physician or other health care practitioner who is licensed to provide health care services or to prescribe pharmaceutical or biologic products.

SB50,7,2 (b) “Pharmaceutical” means a medication that may legally be dispensed only with a valid prescription from a health care professional.

SB50,7,5 (c) “Pharmaceutical representative” means an individual who markets or promotes pharmaceuticals to health care professionals on behalf of a pharmaceutical manufacturer for compensation.

SB50,7,9 (d) “Wholesale acquisition cost” means the most recently reported manufacturer list or catalog price for a brand-name or generic drug available to wholesalers or direct purchasers in the United States, before application of discounts, rebates, or reductions in price.

SB50,7,16 (2) Licensure. (a) No individual may act as a pharmaceutical representative in this state without being licensed by the commissioner as a pharmaceutical representative under this section. In order to obtain or renew a license, the individual shall apply to the commissioner in the form and manner prescribed by the commissioner. The term of a license issued under this paragraph is one year and is renewable. The application to obtain or renew a license shall include all of the following information:

SB50,7,18 1. The applicant’s full name, residence address and telephone number, and business address and telephone number.

SB50,7,19 2. A description of the type of work in which the applicant will engage.

SB50,7,20 3. The fee under s. 601.31 (1) (nv).

SB50,7,22 4. An attestation that the applicant meets the professional education requirements under sub. (3).

SB50,7,23 5. Proof that the applicant has paid any assessed penalties and fees.

SB50,8,1 6. Any other information required by the commissioner by rule.

SB50,8,7 (b) The pharmaceutical representative licensed under par. (a) shall notify the commissioner in writing of any change to the information submitted on an application under par. (a) or any material change to the pharmaceutical representative’s business operations or to any other information provided under this section. The pharmaceutical representative shall provide the notification no later than 4 business days after the change or material change occurs.

SB50,8,10 (c) A pharmaceutical representative licensed under par. (a) shall display the pharmaceutical representative’s license during each visit with a health care professional.

SB50,8,15 (3) Professional education requirements. (a) In order to become initially licensed under sub. (2) (a), a pharmaceutical representative shall complete a professional education course approved by the commissioner. A pharmaceutical representative shall, upon request, provide the commissioner with proof that he or she has completed an approved professional education course.

SB50,8,21 (b) In order to renew a license under sub. (2) (a), a pharmaceutical representative shall complete a minimum of 5 hours of continuing professional education courses. A pharmaceutical representative who has renewed a license under sub. (2) (a) shall, upon request, provide the commissioner with proof that he or she has completed a minimum of 5 hours of continuing professional education courses.

SB50,9,2 (c) The professional education coursework required under pars. (a) and (b) shall include training in ethical standards, whistleblower protections, laws and rules applicable to pharmaceutical marketing, and other subjects that the commissioner identifies by rule.

SB50,9,4 (d) The commissioner shall regularly designate courses that fulfill the requirements under this subsection and publish a list of the designated courses.

SB50,9,9 (e) The professional education coursework required under this subsection may not be provided by the employer of a pharmaceutical representative or be funded, in any way, by the pharmaceutical industry or a 3rd party funded by the pharmaceutical industry. A provider of a course designated under par. (d) shall disclose any conflict of interest to the commissioner.

SB50,9,13 (4) Disclosure to commissioner. (a) No later than June 1 of each year, a pharmaceutical representative licensed under sub. (2) (a) shall provide to the commissioner, in the manner prescribed by the commissioner, all of the following information from the previous calendar year:

SB50,9,16 1. The total number of times the pharmaceutical representative contacted health care professionals in this state and the specialties of the health care professionals contacted.

SB50,9,20 2. For each contact with a health care professional in this state, the location and duration of the contact, the pharmaceuticals for which the pharmaceutical representative provided information, and the value of any item, including a product sample, compensation, material, or gift, provided to the health care professional.

SB50,9,23 (b) The commissioner shall publish the information received under par. (a) on the commissioner’s website in a manner in which individual health care professionals are not identifiable by name or other identifiers.

SB50,10,6 (5) Disclosure to health care professionals. During each contact with a health care professional, a pharmaceutical representative licensed under sub. (2) (a) shall disclose the wholesale acquisition cost of any pharmaceutical for which the pharmaceutical representative provides information and the names of at least 3 generic prescription drugs from the same therapeutic class or, if 3 are not available, as many as are available for prescriptive use.

SB50,10,11 (6) Ethical standards. The commissioner shall promulgate rules that contain ethical standards for pharmaceutical representatives and shall publish the ethical standards on the commissioner’s website. A pharmaceutical representative licensed under sub. (2) (a) shall comply with the ethical standards contained in the rules and may not do any of the following:

SB50,10,14 (a) Engage in deceptive or misleading marketing of a pharmaceutical, including the knowing concealment, suppression, omission, misleading representation, or misstatement of a material fact.