LRB-5192/1
TJD&EKL:cdc
2021 - 2022 LEGISLATURE
November 17, 2021 - Introduced by Representatives Kurtz, Swearingen, Goyke,
James, Petryk, Summerfield, Andraca, Baldeh, Behnke, Billings, Bowen,
Brandtjen, Cabral-Guevara, Callahan, Conley, Considine, Dittrich,
Doyle, Drake, Duchow, Edming, Emerson, Gundrum, Haywood, Hintz,
Kerkman, Kitchens, Knodl, Krug, Macco, Magnafici, B. Meyers, Milroy,
Moses, Mursau, L. Myers, Neubauer, Novak, Ohnstad, Oldenburg,
Ortiz-Velez, Plumer, Pope, Riemer, J. Rodriguez, Rozar, Schraa,
Shankland, Shelton, Skowronski, Snodgrass, Snyder, Spiros, Spreitzer,
Thiesfeldt, Tranel, Vining, Vruwink, Wichgers, Sinicki, Stubbs and Tusler,
cosponsored by Senators Darling, Marklein, Erpenbach, Bernier, Bewley,
Feyen, Jacque, Johnson, Nass, Petrowski, Pfaff, Ringhand, Roys, Smith, L.
Taylor, Wirch, Wanggaard, Cowles and Carpenter. Referred to Committee
on Health.
AB718,1,2
1An Act to create 628.34 (5m) of the statutes;
relating to: prohibiting certain
2practices relating to insurance coverage of clinician-administered drugs.
Analysis by the Legislative Reference Bureau
This bill prohibits certain practices relating to clinician-administered drugs
under the state's insurance unfair marketing and trade practices law. The bill
defines “clinician-administered drug” as an outpatient prescription drug, other than
a vaccine, that, due to medical necessity, cannot reasonably be self-administered by
the patient or an individual assisting the patient and is typically administered by an
authorized health care provider in a physician's office, hospital outpatient
department, or other clinical setting. Under the bill, an insurer offering a health
benefit plan, a pharmacy benefit manager, or an agent of the insurer or pharmacy
benefit manager may not do any of the following:
1. Refuse to authorize, approve, or pay a participating provider for providing
a covered clinician-administered drug and related services to an enrollee,
policyholder, or insured.