LRB-0437/1
JPC:cdc
2023 - 2024 LEGISLATURE
2023 ASSEMBLY BILL 584
October 31, 2023 - Introduced by Representatives J . ANDERSON, BILLINGS,
SHANKLAND, C. ANDERSON, BARE, CABRERA, CONSIDINE, DONOVAN, EMERSON,
JOERS, MOORE OMOKUNDE, ORTIZ-VELEZ, PALMERI, RATCLIFF, SHELTON, STUBBS,
SUBECK, SINICKI, CLANCY and JACOBSON, cosponsored by Senators PFAFF,
CARPENTER, HESSELBEIN, L. JOHNSON, LARSON, ROYS, SMITH and SPREITZER.
Referred to Committee on Insurance.
***AUTHORS SUBJECT TO CHANGE***
AN ACT to renumber and amend 632.895 (6); to amend 609.83 and 632.895 (6)
(title); and to create 632.895 (6) (b) of the statutes; relating to: cost-sharing
cap on insulin.
Analysis by the Legislative Reference Bureau
This bill prohibits every health insurance policy and governmental
self-insured health plan that cover insulin and impose cost sharing on prescription
drugs from imposing cost sharing on insulin in an amount that exceeds $35 for a
one-month supply. Current law requires every health insurance policy that provides
coverage of expenses incurred for treatment of diabetes to provide coverage for
specified expenses and items, including insulin. The required coverage under
current law for certain diabetes treatments other than insulin infusion pumps is
subject to the same exclusions, limitations, deductibles, and coinsurance provisions
of the policy as other covered expenses. The bill's cost-sharing limitation on insulin
supersedes the specification that the exclusions, limitations, deductibles, and
coinsurance are the same as for other coverage.
This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
1
2
3 - 2 -2023 - 2024 Legislature LRB-0437/1
JPC:cdc
SECTION 1 ASSEMBLY BILL 584
SECTION 1. 609.83 of the statutes is amended to read:
609.83 Coverage of drugs and devices. Limited service health
organizations, preferred provider plans, and defined network plans are subject to ss.
632.853, 632.861, and 632.895 (6) (b), (16t), and (16v).
SECTION 2. 632.895 (6) (title) of the statutes is amended to read:
632.895 (6) (title) EQUIPMENT AND SUPPLIES FOR TREATMENT OF DIABETES; INSULIN.
SECTION 3. 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and
amended to read:
632.895 (6) (a) Every disability insurance policy which that provides coverage
of expenses incurred for treatment of diabetes shall provide coverage for expenses
incurred by the installation and use of an insulin infusion pump, coverage for all
other equipment and supplies, including insulin or any other prescription
medication, used in the treatment of diabetes, and coverage of diabetic
self-management education programs. Coverage Except as provided in par. (b),
coverage required under this subsection shall be subject to the same exclusions,
limitations, deductibles, and coinsurance provisions of the policy as other covered
expenses, except that insulin infusion pump coverage may be limited to the purchase
of one pump per year and the insurer may require the insured to use a pump for 30
days before purchase.
SECTION 4. 632.895 (6) (b) of the statutes is created to read:
632.895 (6) (b) 1. In this paragraph:
a. “Cost sharing” means the total of any deductible, copayment, or coinsurance
amounts imposed on a person covered under a policy or plan.
b. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24 - 3 -2023 - 2024 Legislature
LRB-0437/1
JPC:cdc
SECTION 4
ASSEMBLY BILL 584
2. Every disability insurance policy and self-insured health plan that cover
insulin and impose cost sharing on prescription drugs may not impose cost sharing
on insulin in an amount that exceeds $35 for a one-month supply of insulin.
3. Nothing in this paragraph prohibits a disability insurance policy or
self-insured health plan from imposing cost sharing on insulin in an amount less
than the amount specified under subd. 2. Nothing in this paragraph requires a
disability insurance policy or self-insured health plan to impose any cost sharing on
insulin.
SECTION 5.0Effective date.
(1) This act takes effect on the first day of the 4th month beginning after
publication.
(END)
1
2
3
4
5
6
7
8
9
10
11
12