AB68-SSA1,1367,33 b. A valid insulin prescription.
AB68-SSA1,1367,64 c. A valid Wisconsin driver's license or state identification card. If the
5individual is under the age of 18, the individual's parent or legal guardian shall meet
6this requirement.
AB68-SSA1,1367,147 2. Upon receipt of the information described in subd. 1. a. to c., the pharmacist
8shall dispense a 30-day supply of the prescribed insulin to the individual. The
9pharmacy shall also provide the individual with the information sheet described in
10sub. (8) (b) 2. and the list of navigators described in sub. (8) (c). The pharmacy may
11collect a copayment, not to exceed $35, from the individual to cover the pharmacy's
12costs of processing and dispensing the insulin. The pharmacy shall notify the health
13care practitioner who issued the prescription no later than 72 hours after the insulin
14is dispensed.
AB68-SSA1,1367,2215 3. A pharmacy that dispenses insulin under subd. 2. may submit to the
16manufacturer, or the manufacturer's vendor, a claim for payment that is in
17accordance with the national council for prescription drug programs' standards for
18electronic claims processing, except that no claim may be submitted if the
19manufacturer agrees to send the pharmacy a replacement of the same insulin in the
20amount dispensed. If the pharmacy submits an electronic claim, the manufacturer
21or vendor shall reimburse the pharmacy in an amount that covers the pharmacy's
22acquisition cost.
AB68-SSA1,1367,2423 4. A pharmacy that dispenses insulin under subd. 2. shall retain a copy of the
24application form described in subd. 1. a.
AB68-SSA1,1368,7
1(d) Eligibility of certain individuals. An individual who has applied for public
2assistance under ch. 49 but for whom a determination of eligibility has not been made
3or whose coverage has not become effective or an individual who has an appeal
4pending under sub. (3) c. 4. may access insulin under this subsection if the individual
5is in urgent need of insulin. To access a 30-day supply of insulin, the individual shall
6attest to the pharmacy that the individual is described in this paragraph and comply
7with par. (c) 1.
AB68-SSA1,1368,12 8(3) Patient assistance program. (a) Establishment of program. No later than
9July 1, 2022, each manufacturer shall establish a patient assistance program to
10make insulin available in accordance with this subsection to individuals who meet
11the eligibility requirements under par. (b). Under the program, the manufacturer
12shall do all of the following:
AB68-SSA1,1368,1513 1. Provide the commissioner with information regarding the program,
14including contact information for individuals to call for assistance in accessing the
15program.
AB68-SSA1,1368,1716 2. Provide a hotline for individuals to call or access between 8 a.m. and 10 p.m.
17on weekdays and between 10 a.m. and 6 p.m. on Saturdays.
AB68-SSA1,1368,1918 3. List the eligibility requirements under par. (b) on the manufacturer's
19Internet site.
AB68-SSA1,1368,2320 4. Maintain the privacy of all information received from an individual applying
21for or participating in the program and not sell, share, or disseminate the
22information unless required under this section or authorized, in writing, by the
23individual.
AB68-SSA1,1368,2524 (b) Eligible individual. An individual shall be eligible to receive insulin under
25a patient assistance program if all of the following conditions are met:
AB68-SSA1,1369,1
11. The individual is a resident of this state.
AB68-SSA1,1369,42 2. The individual, or the individual's parent or legal guardian if the individual
3is under the age of 18, has a valid Wisconsin driver's license or state identification
4card.
AB68-SSA1,1369,55 3. The individual has a valid insulin prescription.
AB68-SSA1,1369,86 4. The family income of the individual does not exceed 400 percent of the
7poverty line as defined and revised annually under 42 USC 9902 (2) for a family the
8size of the individual's family,
AB68-SSA1,1369,99 5. The individual is not receiving public assistance under ch. 49.
AB68-SSA1,1369,1510 6. The individual is not eligible to receive health care through a federally
11funded program or receive prescription drug benefits through the U.S. department
12of veterans affairs, except that this subdivision does not apply to an individual who
13is enrolled in a policy under Part D of Medicare under 42 USC 1395w-101 et seq. if
14the individual has spent at least $1,000 on prescription drugs in the current calendar
15year.
AB68-SSA1,1369,2016 7. The individual is not enrolled in prescription drug coverage through an
17individual or group health plan that limits the total cost sharing amount, including
18copayments, deductibles, and coinsurance, that an enrollee is required to pay for a
1930-day supply of insulin to no more than $75, regardless of the type or amount of
20insulin needed.
AB68-SSA1,1370,421 (c) Application for patient assistance program. 1. An individual may apply to
22participate in a patient assistance program by filing an application with the
23manufacturer who established the program, the individual's health care practitioner
24if the practitioner participates in the program, or a navigator included on the list
25under sub. (8) (c). A health care practitioner or navigator shall immediately submit

1the application to the manufacturer. Upon receipt of an application, the
2manufacturer shall determine the individual's eligibility under par. (b) and, except
3as provided in subd. 2., notify the individual of the determination no later than 10
4days after receipt of the application.
AB68-SSA1,1370,105 2. If necessary to determine the individual's eligibility under par. (b), the
6manufacturer may request additional information from an individual who has filed
7an application under subd. 1. no later than 5 days after receipt of the application.
8Upon receipt of the additional information, the manufacturer shall determine the
9individual's eligibility under par. (b) and notify the individual of the determination
10no later than 3 days after receipt of the requested information.
AB68-SSA1,1370,1611 3. Except as provided in subd. 5., if the manufacturer determines under subd.
121. or 2. that the individual is eligible for the patient assistance program, the
13manufacturer shall provide the individual with a statement of eligibility. The
14statement of eligibility shall be valid for 12 months and may be renewed upon a
15determination by the manufacturer that the individual continues to meet the
16eligibility requirements of par. (b).
AB68-SSA1,1371,217 4. If the manufacturer determines under subd. 1. or 2. that the individual is not
18eligible for the patient assistance program, the manufacturer shall provide the
19reason for the determination in the notification under subd. 1. or 2. The individual
20may appeal the determination by filing an appeal with the commissioner that shall
21include all of the information provided to the manufacturer under subds. 1. and 2.
22The commissioner shall establish procedures for deciding appeals under this
23subdivision. The commissioner shall issue a decision no later than 10 days after the
24appeal is filed, and the commissioner's decision shall be final. If the commissioner
25determines that the individual meets the eligibility requirements under par. (b), the

1manufacturer shall provide the individual with the statement of eligibility described
2in subd. 3.
AB68-SSA1,1371,113 5. In the case of an individual who has prescription drug coverage through an
4individual or group health plan, if the manufacturer determines under subd. 1. or 2.
5that the individual is eligible for the patient assistance program but also determines
6that the individual's insulin needs are better addressed through the use of the
7manufacturer's copayment assistance program rather than the patient assistance
8program, the manufacturer shall inform the individual of the determination and
9provide the individual with the necessary coupons to submit to a pharmacy. The
10individual may not be required to pay more than the copayment amount specified in
11par. (d) 2.
AB68-SSA1,1371,1812 (d) Provision of insulin under a patient assistance program. 1. Upon receipt
13from an individual of the eligibility statement described in par. (c) 3. and a valid
14insulin prescription, a pharmacy shall submit an order containing the name of the
15insulin and daily dosage amount to the manufacturer. The pharmacy shall include
16with the order the pharmacy's name, shipping address, office telephone number, fax
17number, electronic mail address, and contact name, as well as any days or times
18when deliveries are not accepted by the pharmacy.
AB68-SSA1,1372,219 2. Upon receipt of an order meeting the requirements under subd. 1., the
20manufacturer shall send the pharmacy a 90-day supply of insulin, or lesser amount
21if requested in the order, at no charge to the individual or pharmacy. The pharmacy
22shall dispense the insulin to the individual associated with the order. The insulin
23shall be dispensed at no charge to the individual, except that the pharmacy may
24collect a copayment from the individual to cover the pharmacy's costs for processing
25and dispensing in an amount not to exceed $50 for each 90-day supply of insulin.

1The pharmacy may not seek reimbursement from the manufacturer or a 3rd-party
2payer.
AB68-SSA1,1372,53 3. The pharmacy may submit a reorder to the manufacturer if the individual's
4eligibility statement described in par. (c) 3. has not expired. The reorder shall be
5treated as an order for purposes of subd. 2.
AB68-SSA1,1372,86 4. Notwithstanding subds. 2. and 3., a manufacturer may send the insulin
7directly to the individual if the manufacturer provides a mail-order service option,
8in which case the pharmacy may not collect a copayment from the individual.
AB68-SSA1,1372,11 9(4) Exceptions. (a) This section does not apply to a manufacturer who shows
10to the commissioner's satisfaction that the manufacturer's annual gross revenue
11from insulin sales in this state does not exceed $2,000,000.