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2. A benefit tier that has a lower deductible, copayment, or coinsurance than
18the benefit tier from which the prescription drug is being removed or reassigned.
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(d) If an enrollee has had an adverse reaction to the generic prescription drug
20or the prescription drug in the same pharmacologic class or with the same
21mechanism of action that is being substituted for an originally prescribed drug, the
22pharmacist or pharmacy may extend the prescription order for the originally
23prescribed drug to fill one 30-day supply of the originally prescribed drug for the
24cost-sharing amount that applies to the prescription drug at the time of the
25substitution.
AB68,2956
1Section
2956. 632.862 of the statutes is created to read:
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2632.862 Application of prescription drug payments. (1) Definitions. In
3this section:
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(a) “Brand name” has the meaning given in s. 450.12 (1) (a).
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(b) “Brand name drug” means any of the following:
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1. A prescription drug that contains a brand name and that has no generic
7equivalent.
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2. A prescription drug that contains a brand name and has a generic equivalent
9but for which the enrollee has received prior authorization from the insurer offering
10the disability insurance policy or the self-insured health plan or authorization from
11a physician to obtain the prescription drug under the policy or plan.
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(c) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
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(d) “Prescription drug” has the meaning given in s. 450.01 (20)
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(e) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
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15(2) Application of discounts. A disability insurance policy that offers a
16prescription drug benefit or a self-insured health plan shall apply to any calculation
17of an out-of-pocket maximum and to any deductible of the policy or plan for an
18enrollee the amount that any discount provided by the manufacturer of a brand
19name drug reduces the cost sharing amount charged to an enrollee for that brand
20name drug.
AB68,2957
21Section
2957. 632.863 of the statutes is created to read:
AB68,1534,22
22632.863 Pharmaceutical representatives. (1) Definitions. In this section:
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(a) “Health care professional” means a physician or other health care
24practitioner who is licensed to provide health care services or to prescribe
25pharmaceutical or biologic products.
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1(b) “Pharmaceutical” means a medication that may legally be dispensed only
2with a valid prescription from a health care professional.
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(c) “Pharmaceutical representative” means an individual who markets or
4promotes pharmaceuticals to health care professionals on behalf of a pharmaceutical
5manufacturer for compensation.
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(d) “Wholesale acquisition cost” means the most recently reported
7manufacturer list or catalog price for a brand-name drug or generic drug available
8to wholesalers or direct purchasers in the United States, before application of
9discounts, rebates, or reductions in price.
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10(2) Licensure. (a) No individual may act as a pharmaceutical representative
11in this state without obtaining a pharmaceutical representative license. In order to
12obtain a license, an individual shall apply to the commissioner, on a form prescribed
13by the commissioner. A license issued under this paragraph shall be renewed on an
14annual basis. The application to obtain or renew a license shall include all of the
15following information:
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1. The applicant's full name, residence address and telephone number, and
17business address and telephone number.
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2. A description of the type of work in which the applicant will engage.
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3. The fee under s. 601.31 (1) (nv).
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4. An attestation that the applicant meets the professional education
21requirements under sub. (3).
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5. Proof that the applicant has paid any assessed penalties and fees.
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6. Any other information required by the commissioner.
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(b) The pharmaceutical representative shall report, in writing, to the
25commissioner any change to the information submitted on the application under par.
1(a) or any material change to the pharmaceutical representative's business
2operations or to any information provided under this section. The report shall be
3made no later than 4 business days after the change or material change occurs.
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(c) A pharmaceutical representative shall display his or her license during each
5visit with a health care professional.
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6(3) Professional education requirements. (a) In order to become initially
7licensed under sub. (2) (a), a pharmaceutical representative shall complete a
8professional education course as determined by the commissioner. A pharmaceutical
9representative shall, upon request, provide the commissioner with proof of the
10coursework's completion.
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(b) In order to renew a license under sub. (2) (a), a pharmaceutical
12representative shall complete a minimum of 5 hours of continuing professional
13education courses. A pharmaceutical representative shall, upon request, provide the
14commissioner with proof of the coursework's completion.