Wisconsin Assembly Bill AB654

Wisconsin 2023-2024 Regular Session

• Introduced: 11/9/23
• Refer: 11/9/23
• Failed: 4/15/24

Caption

Utilization management controls for prescription drugs to treat mental illness under the Medical Assistance program. (FE)

Impact

The impact of AB654 is significant as it directly addresses the treatment of serious mental illnesses by preventing restrictions that might delay or limit access to essential prescription drugs. Under the current system, many patients may face hurdles such as prior authorization or step therapy protocols, which can impede timely treatment. By eliminating these barriers for FDA-approved medications, the bill is expected to reduce health disparities among low-income individuals relying on Medical Assistance.

Summary

Assembly Bill 654 aims to enhance access to prescription medications for serious mental illnesses by prohibiting the Department of Health Services from imposing any utilization management controls for prescription drugs approved by the Food and Drug Administration (FDA). This legislation targets crucial medications used in treating disorders such as bipolar disorder, schizophrenia, major depressive disorder, and post-traumatic stress disorder, ensuring that these drugs can be dispensed without additional barriers under the Medical Assistance program.

Contention

Despite its positive intentions, the bill may face contention from stakeholders, particularly health insurers and pharmacy benefit managers who employ utilization management as a means to control costs and ensure the appropriateness of prescribed medications. Critics may express concerns about the potential for increased costs to the state’s Medical Assistance program due to a rise in prescription drug utilization without management controls. This tension reflects the ongoing debate between ensuring patient access to necessary medications and managing state healthcare expenditures effectively.