AB56-SA2,2092i 12Section 2092i. 632.795 (4) (a) of the statutes is amended to read:
AB56-SA2,71,2413 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
14same policy form and for the same premium as it originally offered in the most recent
15enrollment period, subject only to the medical underwriting used in that enrollment
16period. Unless otherwise prescribed by rule, the insurer may apply deductibles,
17preexisting condition limitations, waiting periods , or other limits only to the extent
18that they would have been applicable had coverage been extended at the time of the
19most recent enrollment period and with credit for the satisfaction or partial
20satisfaction of similar provisions under the liquidated insurer's policy or plan. The
21insurer may exclude coverage of claims that are payable by a solvent insurer under
22insolvency coverage required by the commissioner or by the insurance regulator of
23another jurisdiction. Coverage shall be effective on the date that the liquidated
24insurer's coverage terminates.
AB56-SA2,2093k 25Section 2093k. 632.796 of the statutes is created to read:
AB56-SA2,72,2
1632.796 Drug cost report. (1) Definition. In this section, “disability
2insurance policy” has the meaning given in s. 632.895 (1) (a).
AB56-SA2,72,8 3(2) Report required. Annually, at the time the insurer files its rate request
4with the commissioner, each insurer that offers a disability insurance policy that
5covers prescription drugs shall submit to the commissioner a report that identifies
6the 25 prescription drugs that are the highest cost to the insurer and the 25
7prescription drugs that have the highest cost increases over the 12 months before the
8submission of the report.
AB56-SA2,2094k 9Section 2094k. 632.865 (3) of the statutes is created to read:
AB56-SA2,72,1210 632.865 (3) Registration required. (a) No person may perform any activities
11of a pharmacy benefit manager in this state without first registering with the
12commissioner under this subsection.
AB56-SA2,72,1513 (b) The commissioner shall establish a registration procedure for pharmacy
14benefit managers. The commissioner may promulgate any rules necessary to
15implement the registration procedure under this paragraph.
AB56-SA2,2095k 16Section 2095k. 632.866 of the statutes is created to read:
AB56-SA2,72,17 17632.866 Prescription drug cost reporting. (1) Definitions. In this section:
AB56-SA2,72,1918 (a) “Brand-name drug” means a prescription drug approved under 21 USC 355
19(b) or 42 USC 262.
AB56-SA2,72,2120 (b) “Covered hospital” means an entity described in 42 USC 256b (a) (4) (L) to
21(N) that participates in the federal drug-pricing program under 42 USC 256b.
AB56-SA2,72,2222 (c) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB56-SA2,72,2323 (d) “Generic drug” means a prescription drug approved under 21 USC 355 (j).
AB56-SA2,73,3
1(e) “Manufacturer” has the meaning given in s. 450.01 (12). “Manufacturer”
2does not include an entity that is engaged only in the dispensing, as defined in s.
3450.01 (7), of a brand-name drug or a generic drug.
AB56-SA2,73,74 (f) “Manufacturer-sponsored assistance program” means a program offered by
5a manufacturer or an intermediary under contract with a manufacturer through
6which a brand-name drug or a generic drug is provided to a patient at no charge or
7at a discount.
AB56-SA2,73,118 (g) “Margin” means, for a covered hospital, the difference between the net cost
9of a brand-name drug or generic drug covered under the federal drug-pricing
10program under 42 USC 256b and the net payment by the covered hospital for that
11brand-name drug or generic drug.
AB56-SA2,73,1312 (h) “Net payment” means the amount paid for a brand-name drug or generic
13drug after all discounts and rebates have been applied.
AB56-SA2,73,1414 (i) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
AB56-SA2,73,1815 (j) “Wholesale acquisition cost” means the most recently reported
16manufacturer list or catalog price for a brand-name drug or a generic drug available
17to wholesalers or direct purchasers in the United States, before application of
18discounts, rebates, or reductions in price.
AB56-SA2,73,24 19(2) Price increase or introduction notice; justification report. (a) A
20manufacturer shall notify the commissioner if it is increasing the wholesale
21acquisition cost of a brand-name drug on the market in this state by more than 10
22percent or by more than $10,000 during any 12-month period or if it intends to
23introduce to market in this state a brand-name drug that has an annual wholesale
24acquisition cost of $30,000 or more.
AB56-SA2,74,4
1(b) A manufacturer shall notify the commissioner if it is increasing the
2wholesale acquisition cost of a generic drug by more than 25 percent or by more than
3$300 during any 12-month period or if it intends to introduce to market a generic
4drug that has an annual wholesale acquisition cost of $3,000 or more.
AB56-SA2,74,105 (c) The manufacturer shall provide the notice under par. (a) or (b) in writing
6at least 30 days before the planned effective date of the cost increase or drug
7introduction with a justification that includes all documents and research related to
8the manufacturer's selection of the cost increase or introduction price and a
9description of life cycle management, market competition and context, and
10estimated value or cost-effectiveness of the product.
AB56-SA2,74,14 11(3) Net prices paid by pharmacy benefit managers. By March 1 annually, the
12manufacturer shall report to the commissioner the value of price concessions,
13expressed as a percentage of the wholesale acquisition cost, provided to each
14pharmacy benefit manager for each drug sold in this state.
AB56-SA2,74,19 15(4) Rebates and price concessions. By March 1 annually, each pharmacy
16benefit manager shall report to the commissioner the amount received from
17manufacturers as drug rebates and the value of price concessions, expressed as a
18percentage of the wholesale acquisition cost, provided by manufacturers for each
19drug.
AB56-SA2,74,24 20(5) Hospital margin spending. By March 1 annually, each covered hospital
21operating in this state shall report to the commissioner the per unit margin for each
22drug covered under the federal drug pricing program under 42 USC 256b dispensed
23in the previous year multiplied by the number of units dispensed at that margin and
24how the margin revenue was used.
AB56-SA2,75,4
1(6) Manufacturer-sponsored assistance programs. By March 1 annually,
2each manufacturer shall provide the commissioner with a description of each
3manufacturer-sponsored patient assistance program in effect during the previous
4year that includes all of the following:
AB56-SA2,75,55 (a) The terms of the programs.
AB56-SA2,75,66 (b) The number of prescriptions provided to state residents under the program.