September 10, 2021 - Introduced by Representatives Subeck, Anderson,
Cabral-Guevara, Cabrera, Conley, Considine, Emerson, Hebl, Hesselbein,
Hong, B. Meyers, Milroy, L. Myers, Neubauer, Pope, S. Rodriguez,
Shankland, Shelton, Sinicki, Snodgrass, Spreitzer, Stubbs, Vining and
Vruwink, cosponsored by Senators Erpenbach, Johnson, Agard, Bewley,
Carpenter, Larson, Pfaff, Ringhand, Roys and Wirch. Referred to
Committee on Health.

This bill requires insulin manufacturers to establish a program under which
qualifying Wisconsin residents who are in urgent need of insulin and are uninsured
or have limited insurance coverage can be dispensed insulin at a pharmacy. Under
the program, if a qualifying individual in urgent need of insulin provides a pharmacy
with a form attesting that the individual meets the program's eligibility
requirements, specified proof of residency, and a valid insulin prescription, the
pharmacy must dispense a 30-day supply of insulin to the individual and may charge
the individual a copayment of no more than $35. The pharmacy may submit an
electronic payment claim for the insulin's acquisition cost to the manufacturer or
agree to receive a replacement of the same insulin in the amount dispensed.

The bill also requires that insulin manufacturers establish a patient assistance
program to make insulin available to any qualifying Wisconsin resident who is
uninsured or has limited insurance coverage and whose income does not exceed 400
percent of the federal poverty guidelines. Under the bill, an individual must apply
to participate in a manufacturer's program. If the manufacturer determines that the
individual meets the program's eligibility requirements, the manufacturer issues
the individual a statement of eligibility, which is valid for 12 months and may be
renewed. Under the bill, if an individual with a statement of eligibility and valid
insulin prescription requests insulin from a pharmacy, the pharmacy must submit
an order to the manufacturer, who must then provide a 90-day supply of insulin at

no charge to the individual or pharmacy. The pharmacy may charge the individual
a copayment of no more than $50. Under the bill, a manufacturer is not required to
issue a statement of eligibility if the individual has prescription drug coverage
through an individual or group health plan and the manufacturer determines that
the individual's insulin needs are better addressed through the manufacturer's
copayment assistance program. In such case, the manufacturer must provide the
individual with the necessary drug coupons, and the individual may not be required
to pay more than a $50 copayment for a 90-day supply of insulin.

Under the bill, if the manufacturer determines that an individual is not eligible
for the patient assistance program, the individual may file an appeal with the Office
of the Commissioner of Insurance. The bill directs OCI to establish procedures for
deciding appeals. Under the bill, OCI must issue a decision within 10 days, and that
decision is final.

The bill requires that insulin manufacturers annually report to OCI
information about the number of patients served and amount of insulin dispensed
under the programs and that OCI annually report to the legislature on the programs.
The bill also directs OCI to conduct public outreach and develop an information sheet
about the programs, conduct satisfaction surveys of individuals and pharmacies who
participate in the programs, and report to the legislature on the surveys by July 1,
2024. Additionally, the bill requires that OCI develop a training program for health
care navigators to assist individuals in accessing appropriate long-term insulin
options and maintain a list of trained navigators.

The bill provides that a manufacturer that fails to comply with the bill's
provisions may be assessed a penalty of up to $200,000 per month of noncompliance,
which increases to $400,000 if the manufacturer continues to be in noncompliance
after six months and to $600,000 if the manufacturer continues to be in
noncompliance after one year. The bill's requirements do not apply to manufacturers
with annual insulin sales revenue in Wisconsin of no more than $2,000,000 or to
insulin that costs less than a specified dollar amount.