March 14, 2023 - Introduced by Representatives Tittl, Armstrong, Subeck, Behnke, Krug, Murphy, Mursau, Rozar, Schraa, C. Anderson, J. Anderson, Baldeh, Bare, Brooks, Cabrera, Drake, Green, Gundrum, Jacobson, Joers, O’Connor, Ohnstad, Ratcliff, Rodriguez, Schmidt, Schutt, Shankland, Sinicki, Spiros, Stubbs, Wichgers, Clancy and Madison, cosponsored by Senators Jacque, Wanggaard, Carpenter, James, Cabral-Guevara, L. Johnson, Larson, Quinn, Roys and Taylor. Referred to Committee on Health, Aging and Long-Term Care.

AB103,,22An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.) and 609.83; and to create 632.862 of the statutes; relating to: application of prescription drug payments to health insurance cost-sharing requirements.

Health insurance policies and plans often apply deductibles and out-of-pocket maximum amounts to the benefits covered by the policy or plan. A deductible is an amount that an enrollee in a policy or plan must pay out of pocket before attaining the full benefits of the policy or plan. An out-of-pocket maximum amount is a limit specified by a policy or plan on the amount that an enrollee pays, and, once that limit is reached, the policy or plan covers the benefit entirely. This bill generally requires health insurance policies that offer prescription drug benefits, self-insured health plans, and pharmacy benefit managers acting on behalf of policies or plans to apply amounts paid by or on behalf of an individual covered under the policy or plan for brand name prescription drugs to any cost-sharing requirement or to any calculation of an out-of-pocket maximum amount of the policy or plan. Health insurance policies are referred to in the bill as disability insurance policies.

AB103,,6640.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (3) to (6), 632.885, 632.89, 632.895 (5m) and (8) to (17), and 632.896.

AB103,,8840.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.861, 632.862, 632.867, 632.885, 632.89, and 632.895 (11) to (17).