AB43,,8768 2. Any payment made by the pharmacy benefit manager to a consultant or broker who works on behalf of the health benefit plan sponsor.

AB43,,8769 3. From the amounts received from all drug manufacturers, the amounts retained by the pharmacy benefit manager, and not passed through to the health benefit plan sponsor, that are related to the health benefit plan sponsor’s claims or bona fide service fees.

AB43,,8770 4. The amounts, including pharmacy access and audit recovery fees, received from all pharmacies that are in the pharmacy benefit manager’s network or have a contract to be in the network and, from these amounts, the amount retained by the pharmacy benefit manager and not passed through to the health benefit plan sponsor.

AB43,3090 Section 3090. 632.868 of the statutes is created to read:

AB43,,8772 632.868 Insulin safety net programs. (1) Definitions. In this section:

AB43,,8773 (a) “Manufacturer” means a person engaged in the manufacturing of insulin that is self-administered on an outpatient basis.

AB43,,8774 (b) “Navigator” has the meaning given in s. 628.90 (3).

AB43,,8775 (c) “Patient assistance program” means a program established by a manufacturer under sub. (3) (a).

AB43,,8776 (d) “Pharmacy” means an entity licensed under s. 450.06 or 450.065.

AB43,,8777 (e) “Urgent need of insulin” means having less than a 7-day supply of insulin readily available for use and needing insulin in order to avoid the likelihood of suffering a significant health consequence.

AB43,,8778 (f) “Urgent need safety net program” means a program established by a manufacturer under sub. (2) (a).

AB43,,8779 (2) Urgent need safety net program. (a) Establishment of program. No later than July 1, 2024, each manufacturer shall establish an urgent need safety net program to make insulin available in accordance with this subsection to individuals who meet the eligibility requirements under par. (b).

AB43,,8780 (b) Eligible individual. An individual shall be eligible to receive insulin under an urgent need safety net program if all of the following conditions are met:

AB43,,8781 1. The individual is in urgent need of insulin.

AB43,,8782 2. The individual is a resident of this state.

AB43,,8783 3. The individual is not receiving public assistance under ch. 49.

AB43,,8784 4. The individual is not enrolled in prescription drug coverage through an individual or group health plan that limits the total cost sharing amount, including copayments, deductibles, and coinsurance, that an enrollee is required to pay for a 30-day supply of insulin to no more than $75, regardless of the type or amount of insulin prescribed.

AB43,,8785 5. The individual has not received insulin under an urgent need safety net program within the previous 12 months, except as allowed under par. (d).

AB43,,8786 (c) Provision of insulin under an urgent need safety net program. 1. In order to receive insulin under an urgent need safety net program, an individual who meets the eligibility requirements under par. (b) shall provide a pharmacy with all of the following:

AB43,,8787 a. A completed application, on a form prescribed by the commissioner that shall include an attestation by the individual, or the individual’s parent or legal guardian if the individual is under the age of 18, that the individual meets all of the eligibility requirements under par. (b).

AB43,,8788 b. A valid insulin prescription.

AB43,,8789 c. A valid Wisconsin driver’s license or state identification card. If the individual is under the age of 18, the individual’s parent or legal guardian shall meet this requirement.

AB43,,8790 2. Upon receipt of the information described in subd. 1. a. to c., the pharmacist shall dispense a 30-day supply of the prescribed insulin to the individual. The pharmacy shall also provide the individual with the information sheet described in sub. (8) (b) 2. and the list of navigators described in sub. (8) (c). The pharmacy may collect a copayment, not to exceed $35, from the individual to cover the pharmacy’s costs of processing and dispensing the insulin. The pharmacy shall notify the health care practitioner who issued the prescription no later than 72 hours after the insulin is dispensed.

AB43,,8791 3. A pharmacy that dispenses insulin under subd. 2. may submit to the manufacturer, or the manufacturer’s vendor, a claim for payment that is in accordance with the national council for prescription drug programs’ standards for electronic claims processing, except that no claim may be submitted if the manufacturer agrees to send the pharmacy a replacement of the same insulin in the amount dispensed. If the pharmacy submits an electronic claim, the manufacturer or vendor shall reimburse the pharmacy in an amount that covers the pharmacy’s acquisition cost.

AB43,,8792 4. A pharmacy that dispenses insulin under subd. 2. shall retain a copy of the application form described in subd. 1. a.

AB43,,8793 (d) Eligibility of certain individuals. An individual who has applied for public assistance under ch. 49 but for whom a determination of eligibility has not been made or whose coverage has not become effective or an individual who has an appeal pending under sub. (3) (c) 4. may access insulin under this subsection if the individual is in urgent need of insulin. To access a 30-day supply of insulin, the individual shall attest to the pharmacy that the individual is described in this paragraph and comply with par. (c) 1.

AB43,,8794 (3) Patient assistance program. (a) Establishment of program. No later than July 1, 2024, each manufacturer shall establish a patient assistance program to make insulin available in accordance with this subsection to individuals who meet the eligibility requirements under par. (b). Under the patient assistance program, the manufacturer shall do all of the following:

AB43,,8795 1. Provide the commissioner with information regarding the patient assistance program, including contact information for individuals to call for assistance in accessing the patient assistance program.

AB43,,8796 2. Provide a hotline for individuals to call or access between 8 a.m. and 10 p.m. on weekdays and between 10 a.m. and 6 p.m. on Saturdays.