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2023 - 2024 LEGISLATURE
2023 ASSEMBLY BILL 748
December 6, 2023 - Introduced by Representatives SUBECK, C. ANDERSON, J.
ANDERSON, ANDRACA, BARE, BILLINGS, CLANCY, CONLEY, CONSIDINE, DRAKE,
EMERSON, HONG, JACOBSON, JOERS, MADISON, MOORE OMOKUNDE, NEUBAUER,
ORTIZ-VELEZ, PALMERI, RATCLIFF, RIEMER, SHANKLAND, SHELTON, SINICKI,
STUBBS and HAYWOOD, cosponsored by Senators H ESSELBEIN, AGARD,
CARPENTER, L. JOHNSON, PFAFF, ROYS, SMITH, SPREITZER, TAYLOR and WIRCH.
Referred to Committee on Health, Aging and Long-Term Care.
***AUTHORS SUBJECT TO CHANGE***
AN ACT to repeal 49.45 (18) (ag); to renumber and amend 632.895 (6); to
amend 49.45 (18) (ac), 609.83 and 632.895 (6) (title); and to create 20.145 (1)
(a), 49.45 (18) (b) 8., 255.056 (2g), 450.085 (3), 601.31 (1) (nv), 601.31 (1) (nw),
601.41 (13), 601.415 (14), 601.575, 632.863, 632.864, 632.865 (2m), 632.868,
632.869 and 632.895 (6) (b) of the statutes; relating to: health care costs
omnibus, granting rule-making authority, making an appropriation, and
providing a penalty.
Analysis by the Legislative Reference Bureau
Elimination of cost sharing for prescription drugs under the Medical
Assistance program
Under current law, certain persons who receive health services under the
Medical Assistance program, also known in this state as BadgerCare, are required
to contribute a cost-sharing payment to the cost of certain health services. This bill
eliminates all cost-sharing payments for prescription drugs under the Medical
Assistance program. The Medical Assistance program is a joint state and federal
program that provides health services to individuals who have limited financial
resources.
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Cost-sharing cap on insulin
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.
Fiduciary and disclosure requirements for pharmacy benefit managers
The bill imposes fiduciary and disclosure requirements on pharmacy benefit
managers. Pharmacy benefit managers contract with health plans that provide
prescription drug benefits to administer those benefits for the plans. They also have
contracts with pharmacies and pay the pharmacies for providing the drugs to the
plan beneficiaries.
The bill provides that a pharmacy benefit manager owes a fiduciary duty to a
plan sponsor. The bill also requires that a pharmacy benefit manager annually
disclose all of the following information to the plan sponsor:
1. The indirect profit received by the pharmacy benefit manager from owning
a pharmacy or service provider.
2. Any payments made to a consultant or broker who works on behalf of the plan
sponsor.
3. From the amounts received from drug manufacturers, the amounts retained
by the pharmacy benefit manager that are related to the plan sponsor's claims or
bona fide service fees.
4. The amounts received from network pharmacies and the amount retained
by the pharmacy benefit manager.
Reimbursements for certain 340B program entities
The bill prohibits any person from reimbursing certain entities that participate
in the federal drug pricing program, known as the 340B program, for a drug subject
to an agreement under the program at a rate lower than that paid for the same drug
to pharmacies that have a similar prescription volume. The bill also prohibits a
person from imposing any fee, charge back, or other adjustment on the basis of the
entity's participation in the 340B program. The entities covered by the prohibitions
under the bill are federally qualified health centers, critical access hospitals, and
grantees under the federal Ryan White HIV/AIDS program, as well as these entities'
pharmacies and any pharmacy with which any of the entities have contracted to
dispense drugs through the 340B program.
Drug repository program
Under current law, the Department of Health Services must maintain a drug
repository program under which persons may donate certain drugs or supplies that - 3 -2023 - 2024 Legislature
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may be used by other individuals identified by DHS by rule. The bill allows DHS to
partner with out-of-state drug repository programs. The bill also allows
out-of-state persons to donate to the drug repository program in Wisconsin, and
persons in Wisconsin to donate to participating drug repository programs in other
states. Further, the bill directs DHS to study and implement a centralized physical
drug repository program.
Value-based diabetes medication pilot project
The bill directs the Office of the Commissioner of Insurance to develop a pilot
project under which a pharmacy benefit manager and pharmaceutical manufacturer
are directed to create a value-based, sole-source arrangement to reduce the costs of
prescription diabetes medication. The bill allows OCI to promulgate rules to
implement the pilot project.
Pharmacist continuing education credits for volunteering at free and
charitable clinics
Under current law, a licensed pharmacist must renew his or her license every
two years. An applicant for renewal of a pharmacist license must submit proof that
he or she has completed 30 hours of continuing education within the two-year period
immediately preceding the date of his or her application. The bill allows pharmacists
to meet up to 10 hours of the continuing education requirement for each two-year
period by volunteering at a free and charitable clinic.
Prescription drug importation program
The bill requires the commissioner of insurance, in consultation with persons
interested in the sale and pricing of prescription drugs and federal officials and
agencies, to design and implement a prescription drug importation program for the
benefit of and that generates savings for Wisconsin residents. The bill establishes
requirements for the program, including all of the following:
1. The commissioner must designate a state agency to become a licensed
wholesale distributor or contract with a licensed wholesale distributor and to seek
federal certification and approval to import prescription drugs.
2. The program must comply with certain federal regulations and import from
Canadian suppliers only prescription drugs that are not brand-name drugs, have
fewer than four competitor drugs in this country, and for which importation creates
substantial savings.
3. The commissioner must ensure that prescription drugs imported under the
program are not distributed, dispensed, or sold outside of Wisconsin.
4. The program must have an audit procedure to ensure the program complies
with certain requirements specified in the bill.
Before submitting the proposed program to the federal government for
certification, the commissioner must submit the proposed program to the Joint
Committee on Finance for its approval.
Pharmacy benefits tool grants
The bill directs OCI to award grants in an amount of up to $500,000 in each
fiscal year to health care providers to develop and implement a tool that would allow
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usable by physicians and other prescribers to determine the cost of prescription
drugs for their patients. Any health care provider that receives a grant to develop
and implement a patient pharmacy benefits tool is required to contribute matching
funds equal to at least 50 percent of the total grant awarded.
Prescription drug purchasing entity study
The bill requires OCI to conduct a study on the viability of creating or
implementing a state prescription drug purchasing entity.
Licensure of pharmacy services administrative organizations
The bill requires that a pharmacy services administrative organization (PSAO)
be licensed by OCI. Under the bill, a PSAO is an entity operating in Wisconsin that
does all of the following:
1. Contracts with an independent pharmacy to conduct business on the
pharmacy's behalf with a third-party payer.
2. Provides at least one administrative service to an independent pharmacy
and negotiates and enters into a contract with a third-party payer or pharmacy
benefit manager on the pharmacy's behalf.
The bill defines “independent pharmacy" to mean a licensed pharmacy
operating in Wisconsin that is under common ownership with no more than two other
pharmacies. “Administrative service” is defined to mean assisting with claims or
audits, providing centralized payment, performing certification in a specialized care
program, providing compliance support, setting flat fees for generic drugs, assisting
with store layout, managing inventory, providing marketing support, providing
management and analysis of payment and drug dispensing data, or providing
resources for retail cash cards. The bill defines “third-party payer” to mean an entity
operating in Wisconsin that pays or insures health, medical, or prescription drug
expenses on behalf of beneficiaries. The bill uses the current law definition of
“pharmacy benefit manager," which is an entity doing business in Wisconsin that
contracts to administer or manage prescription drug benefits on behalf of an insurer
or other entity that provides prescription drug benefits to Wisconsin residents.
To obtain the license required by the bill, a person must apply to OCI and
provide the contact information for the applicant and a contact person, evidence of
financial responsibility of at least $1,000,000, and any other information required by
the commissioner. Under the bill, the license fee is set by the commissioner, and the
term of a license is two years.
The bill also requires that a PSAO disclose to OCI the extent of any ownership
or control by an entity that provides pharmacy services; provides prescription drug
or device services; or manufactures, sells, or distributes prescription drugs,
biologicals, or medical devices. The PSAO must notify OCI within five days of any
material change in its ownership or control related to such an entity.
Licensure of pharmaceutical representatives
The bill requires a pharmaceutical representative to be licensed by OCI and to
display the pharmaceutical representative's license during each visit with a health
care professional. The bill defines “pharmaceutical representative” to mean an
individual who markets or promotes pharmaceuticals to health care professionals on
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The term of a license issued under the bill is one year, and the license is
renewable. The application to obtain or renew a license must include the applicant's
contact information, a description of the type of work in which the applicant will
engage, the license fee, an attestation that professional education requirements are
met, proof that any penalties and other fees are paid, and any other information
required by OCI. Under the bill, the license fee is set by the commissioner. The bill
requires the pharmaceutical representative to report, within four business days, any
change to the information provided on the application or any material change to the
pharmaceutical representative's business operations or other information required
to be reported under the bill.
The bill requires that a pharmaceutical representative complete a professional
education course prior to becoming licensed and to annually complete at least five
hours of continuing professional education courses. The coursework must include,
at a minimum, training in ethical standards, whistleblower protections, and the laws
and rules applicable to pharmaceutical marketing. The bill directs the commissioner
to regularly publish a list of courses that fulfill the education requirements. Under
the bill, a course provider must disclose any conflict of interest, and the courses may
not be provided by the employer of a pharmaceutical representative or be funded by
the pharmaceutical industry or a third party funded by the industry.
The bill requires that, no later than June 1 of each year, a pharmaceutical
representative report to OCI the pharmaceutical representative's total number of
contacts with health care professionals in Wisconsin, the specialties of those health
care professionals, the location and duration of each contact, the pharmaceuticals
discussed, and the value of any item provided to a health care professional. The bill
directs the commissioner to publish the information on OCI's website, without
identifying individual health care professionals.
The bill requires that a pharmaceutical representative, during each contact
with a health care professional, disclose the wholesale acquisition cost of any
pharmaceuticals discussed and the names of at least three generic prescription
drugs from the same therapeutic class.
The bill directs the commissioner to promulgate ethical standards for
pharmaceutical representatives. Additionally, the bill prohibits a pharmaceutical
representative from engaging in deceptive or misleading marketing of a
pharmaceutical product; using a title or designation that could reasonably lead a
licensed health care professional, or an employee or representative of such a
professional, to believe that the pharmaceutical representative is licensed to practice
in a health occupation unless the pharmaceutical representative holds a license to
practice in that health occupation; or attending a patient examination without the
patient's consent.
An individual who violates any of the requirements under this bill is subject to
a fine, and the individual's license may be suspended or revoked. An individual
whose license is revoked must wait at least two years before applying for a new
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Insulin safety net programs
The 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 each insulin manufacturer establish a patient
assistance program to make insulin available to any qualifying Wisconsin resident
who, among other requirements, is uninsured or has limited insurance coverage and
whose family income does not exceed 400 percent of the federal poverty line. 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 must issue 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 OCI. 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 certain
information, including the number of individuals served and the cost of insulin
dispensed under the programs and that OCI annually report to the governor and 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 that participate in the programs, and report to the
governor and the legislature on the surveys by July 1, 2026. 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
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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 per month if the manufacturer continues to be in
noncompliance after six months and to $600,000 per month 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.
This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.
Because this bill creates a new crime or revises a penalty for an existing crime,
the Joint Review Committee on Criminal Penalties may be requested to prepare a
report.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SECTION 1. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
the following amounts for the purposes indicated:
2023-24 2024-25
20.145 Insurance, office of the commissioner of
(1) SUPERVISION OF THE INSURANCE INDUSTRY
(a)State operations GPR A -0- 500,000
SECTION 2. 20.145 (1) (a) of the statutes is created to read:
20.145 (1) (a) State operations. The amounts in the schedule for general
program operations.
SECTION 3. 49.45 (18) (ac) of the statutes is amended to read:
49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag),
any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the
benefits under s. 49.46 (2) (a) and (b) under s. 49.471, shall pay up to the maximum
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amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided
under s. 49.46 (2). The service provider shall collect the specified or allowable
copayment, coinsurance, or deductible, unless the service provider determines that
the cost of collecting the copayment, coinsurance, or deductible exceeds the amount
to be collected. The department shall reduce payments to each provider by the
amount of the specified or allowable copayment, coinsurance, or deductible. No
provider may deny care or services because the recipient is unable to share costs, but
an inability to share costs specified in this subsection does not relieve the recipient
of liability for these costs.
SECTION 4. 49.45 (18) (ag) of the statutes is repealed.
SECTION 5. 49.45 (18) (b) 8. of the statutes is created to read:
49.45 (18) (b) 8. Prescription drugs.
SECTION 6. 255.056 (2g) of the statutes is created to read:
255.056 (2g) The department may partner with out-of-state drug repository
programs. The department may authorize a medical facility or pharmacy that elects
to participate in the drug repository program to receive drugs or supplies from out
of state, and the department may authorize an out-of-state entity that participates
in a partner out-of-state drug repository program to receive drugs or supplies from
Wisconsin.
SECTION 7. 450.085 (3) of the statutes is created to read:
450.085 (3) An applicant for renewal of a license under s. 450.08 (2) (a) may
count, for purposes of the continuing education requirement under sub. (1), up to 10
hours spent as a volunteer at a free and charitable clinic approved by the board.
SECTION 8. 601.31 (1) (nv) of the statutes is created to read:
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601.31 (1) (nv) For issuing or renewing a license as a pharmaceutical
representative under s. 632.863, an amount to be set by the commissioner by rule.
SECTION 9. 601.31 (1) (nw) of the statutes is created to read:
601.31 (1) (nw) For issuing or renewing a license as a pharmacy services
administrative organization under s. 632.864, an amount to be set by the
commissioner by rule.
SECTION 10. 601.41 (13) of the statutes is created to read:
601.41 (13) VALUE-BASED DIABETES MEDICATION PILOT PROJECT. The
commissioner shall develop a pilot project to direct a pharmacy benefit manager, as
defined in s. 632.865 (1) (c), and a pharmaceutical manufacturer to create a
value-based, sole-source arrangement to reduce the costs of prescription medication
used to treat diabetes. The commissioner may promulgate rules to implement this
subsection.
SECTION 11. 601.415 (14) of the statutes is created to read:
601.415 (14) PATIENT PHARMACY BENEFITS TOOL. (a) From the appropriation
under s. 20.145 (1) (a), beginning in the 2024-25 fiscal year, the office shall award
grants in a total amount of up to $500,000 each fiscal year to health care providers
to develop and implement a tool for prescribers to disclose the cost of prescription
drugs for patients. The tool must be usable by physicians and other prescribers to
determine the cost of prescription drugs for their patients.
(b) Any health care provider that receives a grant under par. (a) shall contribute
matching funds equal to at least 50 percent of the grant amount awarded.
SECTION 12. 601.575 of the statutes is created to read:
601.575 Prescription drug importation program. (1) IMPORTATION
PROGRAM REQUIREMENTS. The commissioner, in consultation with persons interested
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in the sale and pricing of prescription drugs and appropriate officials and agencies
of the federal government, shall design and implement a prescription drug
importation program for the benefit of residents of this state, that generates savings
for residents, and that satisfies all of the following:
(a) The commissioner shall designate a state agency to become a licensed
wholesale distributor or to contract with a licensed wholesale distributor and shall
seek federal certification and approval to import prescription drugs.
(b) The program shall comply with relevant requirements of 21 USC 384,
including safety and cost savings requirements.
(c) The program shall import prescription drugs from Canadian suppliers
regulated under any appropriate Canadian or provincial laws.
(d) The program shall have a process to sample the purity, chemical
composition, and potency of imported prescription drugs.
(e) The program shall import only those prescription drugs for which
importation creates substantial savings for residents of this state and only those
prescription drugs that are not brand-name drugs and that have fewer than 4
competitor prescription drugs in the United States.
(f) The commissioner shall ensure that prescription drugs imported under the
program are not distributed, dispensed, or sold outside of this state.
(g) The program shall ensure all of the following:
1. Participation by any pharmacy or health care provider in the program is
voluntary.
2. Any pharmacy or health care provider participating in the program has the
appropriate license or other credential in this state.
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3. Any pharmacy or health care provider participating in the program charges
a consumer or health plan the actual acquisition cost of the imported prescription
drug that is dispensed.
(h) The program shall ensure that a payment by a health plan or health
insurance policy for a prescription drug imported under the program reimburses no
more than the actual acquisition cost of the imported prescription drug that is
dispensed.
(i) The program shall ensure that any health plan or health insurance policy
participating in the program does all of the following:
1. Maintains a formulary and claims payment system with current information
on prescription drugs imported under the program.
2. Bases cost-sharing amounts for participants or insureds under the plan or
policy on no more than the actual acquisition cost of the prescription drug imported
under the program that is dispensed to the participant or insured.
3. Demonstrates to the commissioner or a state agency designated by the
commissioner how premiums under the plan or policy are affected by savings on
prescription drugs imported under the program.
(j) Any wholesale distributor importing prescription drugs under the program
shall limit its profit margin to the amount established by the commissioner or a state
agency designated by the commissioner.
(k) The program may not import any generic prescription drug that would
violate federal patent laws on branded products in the United States.
(L) The program shall comply with tracking and tracing requirements of 21
USC 360eee and 360eee-1, to the extent practical and feasible, before the
prescription drug to be imported comes into the possession of this state's wholesale
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distributor and fully after the prescription drug to be imported is in the possession
of this state's wholesale distributor.
(m) The program shall establish a fee or other mechanism to finance the
program that does not jeopardize significant savings to residents of this state.
(n) The program shall have an audit function that ensures all of the following:
1. The commissioner has a sound methodology to determine the most
cost-effective prescription drugs to include in the program.
2. The commissioner has a process in place to select Canadian suppliers that
are high quality, high performing, and in full compliance with Canadian laws.
3. Prescription drugs imported under the program are pure, unadulterated,
potent, and safe.
4. The program is complying with the requirements of this subsection.
5. The program is adequately financed to support administrative functions of
the program while generating significant cost savings to residents of this state.
6. The program does not put residents of this state at a higher risk than if the
program did not exist.
7. The program provides and is projected to continue to provide substantial cost
savings to residents of this state.
(2) ANTICOMPETITIVE BEHAVIOR. The commissioner, in consultation with the
attorney general, shall identify the potential for and monitor anticompetitive
behavior in industries affected by a prescription drug importation program.
(3) APPROVAL OF PROGRAM DESIGN; CERTIFICATION. No later than the first day of
the 7th month beginning after the effective date of this subsection .... [LRB inserts
date], the commissioner shall submit to the joint committee on finance a report that
includes the design of the prescription drug importation program in accordance with
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this section. The commissioner may not submit the proposed program to the federal
department of health and human services unless the joint committee on finance
approves the proposed program. Within 14 days of the date of approval by the joint
committee on finance of the proposed program, the commissioner shall submit to the
federal department of health and human services a request for certification of the
approved program.
(4) IMPLEMENTATION OF CERTIFIED PROGRAM. After the federal department of
health and human services certifies the prescription drug importation program
submitted under sub. (3), the commissioner shall begin implementation of the
program, and the program shall be fully operational by 180 days after the date of
certification by the federal department of health and human services. The
commissioner shall do all of the following to implement the program to the extent the
action is in accordance with other state laws and the certification by the federal
department of health and human services:
(a) Become a licensed wholesale distributor, designate another state agency to
become a licensed wholesale distributor, or contract with a licensed wholesale
distributor.
(b) Contract with one or more Canadian suppliers that meet the criteria in sub.
(1) (c) and (n).
(c) Create an outreach and marketing plan to communicate with and provide
information to health plans and health insurance policies, employers, pharmacies,
health care providers, and residents of this state on participating in the program.
(d) Develop and implement a registration process for health plans and health
insurance policies, pharmacies, and health care providers interested in participating
in the program.
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(e) Create a publicly accessible source for listing prices of prescription drugs
imported under the program.
(f) Create, publicize, and implement a method of communication to promptly
answer questions from and address the needs of persons affected by the
implementation of the program before the program is fully operational.
(g) Establish the audit functions under sub. (1) (n) with a timeline to complete
each audit function every 2 years.
(h) Conduct any other activities determined by the commissioner to be
important to successful implementation of the program.
(5) REPORT. By January 1 and July 1 of each year, the commissioner shall
submit to the joint committee on finance a report including all of the following:
(a) A list of prescription drugs included in the prescription drug importation
program under this section.
(b) The number of pharmacies, health care providers, and health plans and
health insurance policies participating in the prescription drug importation program
under this section.
(c) The estimated amount of savings to residents of this state, health plans and
health insurance policies, and employers resulting from the implementation of the
prescription drug importation program under this section reported from the date of
the previous report under this subsection and from the date the program was fully
operational.
(d) Findings of any audit functions under sub. (1) (n) completed since the date
of the previous report under this subsection.
(6) RULEMAKING. The commissioner may promulgate any rules necessary to
implement this section.
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SECTION 13. 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 14. 632.863 of the statutes is created to read:
632.863 Pharmaceutical representatives. (1) DEFINITIONS. In this section:
(a) “Health care professional” means a physician or other health care
practitioner who is licensed to provide health care services or to prescribe
pharmaceutical or biologic products.
(b) “Pharmaceutical” means a medication that may legally be dispensed only
with a valid prescription from a health care professional.
(c) “Pharmaceutical representative” means an individual who markets or
promotes pharmaceuticals to health care professionals on behalf of a pharmaceutical
manufacturer for compensation.
(d) “Wholesale acquisition cost” means the most recently reported
manufacturer list or catalog price for a brand-name or generic drug available to
wholesalers or direct purchasers in the United States, before application of
discounts, rebates, or reductions in price.
(2) LICENSURE. (a) No individual may act as a pharmaceutical representative
in this state without being licensed by the commissioner as a pharmaceutical
representative under this section. In order to obtain a license, the individual shall
apply to the commissioner in the form and manner prescribed by the commissioner.
The term of a license issued under this paragraph is one year and is renewable. The
application to obtain or renew a license shall include all of the following information:
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1. The applicant's full name, residence address and telephone number, and
business address and telephone number.
2. A description of the type of work in which the applicant will engage.
3. The fee under s. 601.31 (1) (nv).
4. An attestation that the applicant meets the professional education
requirements under sub. (3).
5. Proof that the applicant has paid any assessed penalties and fees.
6. Any other information required by the commissioner.
(b) The pharmaceutical representative licensed under par. (a) shall report, in
writing, to the commissioner any change to the information submitted on an
application under par. (a) or any material change to the pharmaceutical
representative's business operations or to any information provided under this
section. The pharmaceutical representative shall make the report no later than 4
business days after the change or material change occurs.
(c) A pharmaceutical representative licensed under par. (a) shall display the
pharmaceutical representative's license during each visit with a health care
professional.
(3) PROFESSIONAL EDUCATION REQUIREMENTS. (a) In order to become initially
licensed under sub. (2) (a), a pharmaceutical representative shall complete a
professional education course as determined by the commissioner. A pharmaceutical
representative shall, upon request, provide the commissioner with proof of the
coursework's completion.
(b) In order to renew a license under sub. (2) (a), a pharmaceutical
representative shall complete a minimum of 5 hours of continuing professional
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education courses. A pharmaceutical representative shall, upon request, provide the
commissioner with proof of the coursework's completion.
(c) The professional education coursework required under pars. (a) and (b) shall
include training in ethical standards, whistleblower protections, laws and rules
applicable to pharmaceutical marketing, and other subjects that the commissioner
may identify by rule.
(d) The commissioner shall regularly designate courses that fulfill the
requirements under this subsection and publish a list of the designated courses.
(e) The professional education coursework required under this subsection may
not be provided by the employer of a pharmaceutical representative or be funded, in
any way, by the pharmaceutical industry or a 3rd party funded by the
pharmaceutical industry. A provider of a course designated under par. (d) shall
disclose any conflict of interest.
(4) DISCLOSURE TO COMMISSIONER. (a) No later than June 1 of each year, a
pharmaceutical representative licensed under sub. (2) (a) shall provide to the
commissioner, in the manner prescribed by the commissioner, all of the following
information from the previous calendar year:
1. The total number of times the pharmaceutical representative contacted
health care professionals in this state and the specialties of the health care
professionals contacted.
2. For each contact with a health care professional in this state, the location and
duration of the contact, the pharmaceuticals for which the pharmaceutical
representative provided information, and the value of any item, including a product
sample, compensation, material, or gift, provided to the health care professional.
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(b) The commissioner shall publish the information received under par. (a) on
the commissioner's website in a manner in which individual health care
professionals are not identifiable by name or other identifiers.
(5) DISCLOSURE TO HEALTH CARE PROFESSIONALS. During each contact with a
health care professional, a pharmaceutical representative licensed under sub. (2) (a)
shall disclose the wholesale acquisition cost of any pharmaceutical for which the
pharmaceutical representative provides information and the names of at least 3
generic prescription drugs from the same therapeutic class or, if 3 are not available,
as many as are available for prescriptive use.
(6) ETHICAL STANDARDS. The commissioner shall promulgate rules that contain
ethical standards for pharmaceutical representatives and shall publish the ethical
standards on the commissioner's website. A pharmaceutical representative licensed
under sub. (2) (a) shall comply with the ethical standards contained in the rules and
may not do any of the following:
(a) Engage in deceptive or misleading marketing of a pharmaceutical,
including the knowing concealment, suppression, omission, misleading
representation, or misstatement of a material fact.
(b) Use a title or designation that could reasonably lead a licensed health care
professional, or an employee or representative of a licensed health care professional,
to believe that the pharmaceutical representative is licensed to practice medicine,
nursing, dentistry, optometry, pharmacy, or other similar health occupation in this
state unless the pharmaceutical representative holds that license to practice.
(c) Attend a patient examination without the patient's consent.
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(7) ENFORCEMENT. (a) Any individual who violates this section shall be fined
not less than $1,000 nor more than $3,000 for each offense. Each day of continued
violation constitutes a separate offense.
(b) The commissioner may suspend or revoke the license of a pharmaceutical
representative who violates this section. A suspended or revoked license may not be
reinstated until the pharmaceutical representative remedies all violations related
to the suspension or revocation and pays all assessed penalties and fees. A
pharmaceutical representative whose license is revoked for any cause may not be
issued a license under sub. (2) (a) until at least 2 years after the date of revocation.
(c) A health care professional who meets with a pharmaceutical representative
who does not display the pharmaceutical representative's license or share the
information required under sub. (5) may report the pharmaceutical representative
to the commissioner.
(8) RULES. The commissioner may promulgate rules to implement this section.
SECTION 15. 632.864 of the statutes is created to read:
632.864 Pharmacy services administrative organizations . (1)
DEFINITIONS. In this section:
(a) “Administrative service” means any of the following:
1. Assisting with claims.
2. Assisting with audits.
3. Providing centralized payment.
4. Performing certification in a specialized care program.
5. Providing compliance support.
6. Setting flat fees for generic drugs.
7. Assisting with store layout.
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8. Managing inventory.
9. Providing marketing support.
10. Providing management and analysis of payment and drug dispensing data.
11. Providing resources for retail cash cards.
(b) “Independent pharmacy" means a pharmacy operating in this state that is
licensed under s. 450.06 or 450.065 and is under common ownership with no more
than 2 other pharmacies.
(c) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
(d) “Pharmacy services administrative organization” means an entity
operating in this state that does all of the following:
1. Contracts with an independent pharmacy to conduct business on the
independent pharmacy's behalf with a 3rd-party payer.
2. Provides at least one administrative service to an independent pharmacy
and negotiates and enters into a contract with a 3rd-party payer or pharmacy benefit
manager on behalf of the independent pharmacy.
(e) “Third-party payer” means an entity, including a plan sponsor, health
maintenance organization, or insurer, operating in this state that pays or insures
health, medical, or prescription drug expenses on behalf of beneficiaries.
(2) LICENSURE. (a) No person may operate as a pharmacy services
administrative organization in this state without being licensed by the commissioner
as a pharmacy services administrative organization under this section. In order to
obtain a license, the person shall apply to the commissioner in the form and manner
prescribed by the commissioner. The application shall include all of the following:
1. The name, address, telephone number, and federal employer identification
number of the applicant.
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2. The name, business address, and telephone number of a contact person for
the applicant.
3. The fee under s. 601.31 (1) (nw).
4. Evidence of financial responsibility of at least $1,000,000.
5. Any other information required by the commissioner.
(b) The term of a license issued under par. (a) shall be 2 years from the date of
issuance.
(3) DISCLOSURE TO THE COMMISSIONER. (a) A pharmacy services administrative
organization licensed under sub. (2) shall disclose to the commissioner the extent of
any ownership or control of the pharmacy services administrative organization by
an entity that does any of the following:
1. Provides pharmacy services.
2. Provides prescription drug or device services.
3. Manufactures, sells, or distributes prescription drugs, biologicals, or medical
devices.
(b) A pharmacy services administrative organization licensed under sub. (2)
shall notify the commissioner in writing within 5 days of any material change in its
ownership or control relating to an entity described in par. (a).
(4) RULES. The commissioner may promulgate rules to implement this section.
SECTION 16. 632.865 (2m) of the statutes is created to read:
632.865 (2m) FIDUCIARY DUTY AND DISCLOSURES TO HEALTH BENEFIT PLAN
SPONSORS. (a) A pharmacy benefit manager owes a fiduciary duty to the health
benefit plan sponsor to act according to the health benefit plan sponsor's instructions
and in the best interests of the health benefit plan sponsor.
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(b) A pharmacy benefit manager shall annually provide, no later than the date
and using the method prescribed by the commissioner by rule, the health benefit plan
sponsor all of the following information from the previous calendar year:
1. The indirect profit received by the pharmacy benefit manager from owning
any interest in a pharmacy or service provider.
2. Any payment made by the pharmacy benefit manager to a consultant or
broker who works on behalf of the health benefit plan sponsor.
3. From the amounts received from all drug manufacturers, the amounts
retained by the pharmacy benefit manager, and not passed through to the health
benefit plan sponsor, that are related to the health benefit plan sponsor's claims or
bona fide service fees.
4. The amounts, including pharmacy access and audit recovery fees, received
from all pharmacies that are in the pharmacy benefit manager's network or have a
contract to be in the network and, from these amounts, the amount retained by the
pharmacy benefit manager and not passed through to the health benefit plan
sponsor.
SECTION 17. 632.868 of the statutes is created to read:
632.868 Insulin safety net programs. (1) DEFINITIONS. In this section:
(a) “Manufacturer" means a person engaged in the manufacturing of insulin
that is self-administered on an outpatient basis.
(b) “Navigator" has the meaning given in s. 628.90 (3).
(c) “Patient assistance program” means a program established by a
manufacturer under sub. (3) (a).
(d) “Pharmacy" means an entity licensed under s. 450.06 or 450.065.
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(e) “Urgent need of insulin" means having less than a 7-day supply of insulin
readily available for use and needing insulin in order to avoid the likelihood of
suffering a significant health consequence.
(f) “Urgent need safety net program” means a program established by a
manufacturer under sub. (2) (a).
(2) URGENT NEED SAFETY NET PROGRAM. (a) Establishment of program. No later
than July 1, 2024, each manufacturer shall establish an urgent need safety net
program to make insulin available in accordance with this subsection to individuals
who meet the eligibility requirements under par. (b).
(b) Eligible individual. An individual shall be eligible to receive insulin under
an urgent need safety net program if all of the following conditions are met:
1. The individual is in urgent need of insulin.
2. The individual is a resident of this state.
3. The individual is not receiving public assistance under ch. 49.
4. The individual is not enrolled in prescription drug coverage through an
individual or group health plan that limits the total cost sharing amount, including
copayments, deductibles, and coinsurance, that an enrollee is required to pay for a
30-day supply of insulin to no more than $75, regardless of the type or amount of
insulin prescribed.
5. The individual has not received insulin under an urgent need safety net
program within the previous 12 months, except as allowed under par. (d).
(c) Provision of insulin under an urgent need safety net program. 1. In order
to receive insulin under an urgent need safety net program, an individual who meets
the eligibility requirements under par. (b) shall provide a pharmacy with all of the
following:
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a. A completed application, on a form prescribed by the commissioner that shall
include an attestation by the individual, or the individual's parent or legal guardian
if the individual is under the age of 18, that the individual meets all of the eligibility
requirements under par. (b).
b. A valid insulin prescription.
c. A valid Wisconsin driver's license or state identification card. If the
individual is under the age of 18, the individual's parent or legal guardian shall meet
this requirement.
2. Upon receipt of the information described in subd. 1. a. to c., the pharmacist
shall dispense a 30-day supply of the prescribed insulin to the individual. The
pharmacy shall also provide the individual with the information sheet described in
sub. (8) (b) 2. and the list of navigators described in sub. (8) (c). The pharmacy may
collect a copayment, not to exceed $35, from the individual to cover the pharmacy's
costs of processing and dispensing the insulin. The pharmacy shall notify the health
care practitioner who issued the prescription no later than 72 hours after the insulin
is dispensed.
3. A pharmacy that dispenses insulin under subd. 2. may submit to the
manufacturer, or the manufacturer's vendor, a claim for payment that is in
accordance with the national council for prescription drug programs' standards for
electronic claims processing, except that no claim may be submitted if the
manufacturer agrees to send the pharmacy a replacement of the same insulin in the
amount dispensed. If the pharmacy submits an electronic claim, the manufacturer
or vendor shall reimburse the pharmacy in an amount that covers the pharmacy's
acquisition cost.
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4. A pharmacy that dispenses insulin under subd. 2. shall retain a copy of the
application form described in subd. 1. a.
(d) Eligibility of certain individuals. An individual who has applied for public
assistance under ch. 49 but for whom a determination of eligibility has not been made
or whose coverage has not become effective or an individual who has an appeal
pending under sub. (3) (c) 4. may access insulin under this subsection if the
individual is in urgent need of insulin. To access a 30-day supply of insulin, the
individual shall attest to the pharmacy that the individual is described in this
paragraph and comply with par. (c) 1.
(3) PATIENT ASSISTANCE PROGRAM. (a) Establishment of program. No later than
July 1, 2024, each manufacturer shall establish a patient assistance program to
make insulin available in accordance with this subsection to individuals who meet
the eligibility requirements under par. (b). Under the patient assistance program,
the manufacturer shall do all of the following:
1. Provide the commissioner with information regarding the patient assistance
program, including contact information for individuals to call for assistance in
accessing the patient assistance program.
2. Provide a hotline for individuals to call or access between 8 a.m. and 10 p.m.
on weekdays and between 10 a.m. and 6 p.m. on Saturdays.
3. List the eligibility requirements under par. (b) on the manufacturer's
website.
4. Maintain the privacy of all information received from an individual applying
for or participating in the patient assistance program and not sell, share, or
disseminate the information unless required under this section or authorized, in
writing, by the individual.
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(b) Eligible individual. An individual shall be eligible to receive insulin under
a patient assistance program if all of the following conditions are met:
1. The individual is a resident of this state.
2. The individual, or the individual's parent or legal guardian if the individual
is under the age of 18, has a valid Wisconsin driver's license or state identification
card.
3. The individual has a valid insulin prescription.
4. The family income of the individual does not exceed 400 percent of the
poverty line as defined and revised annually under 42 USC 9902 (2) for a family the
size of the individual's family.
5. The individual is not receiving public assistance under ch. 49.
6. The individual is not eligible to receive health care through a federally
funded program or receive prescription drug benefits through the U.S. department
of veterans affairs, except that this subdivision does not apply to an individual who
is enrolled in a policy under Part D of Medicare under 42 USC 1395w-101 et seq. if
the individual has spent at least $1,000 on prescription drugs in the current calendar
year.
7. The individual is not enrolled in prescription drug coverage through an
individual or group health plan that limits the total cost sharing amount, including
copayments, deductibles, and coinsurance, that an enrollee is required to pay for a
30-day supply of insulin to no more than $75, regardless of the type or amount of
insulin needed.
(c) Application for patient assistance program. 1. An individual may apply to
participate in a patient assistance program by filing an application with the
manufacturer that established the patient assistance program, the individual's
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health care practitioner if the practitioner participates in the patient assistance
program, or a navigator included on the list under sub. (8) (c). A health care
practitioner or navigator shall immediately submit the application to the
manufacturer. Upon receipt of an application, the manufacturer shall determine the
individual's eligibility under par. (b) and, except as provided in subd. 2., notify the
individual of the determination no later than 10 days after receipt of the application.
2. If necessary to determine the individual's eligibility under par. (b), the
manufacturer may request additional information from an individual who has filed
an application under subd. 1. no later than 5 days after receipt of the application.
Upon receipt of the additional information, the manufacturer shall determine the
individual's eligibility under par. (b) and notify the individual of the determination
no later than 3 days after receipt of the requested information.
3. Except as provided in subd. 5., if the manufacturer determines under subd.
1. or 2. that the individual is eligible for the patient assistance program, the
manufacturer shall provide the individual with a statement of eligibility. The
statement of eligibility shall be valid for 12 months and may be renewed upon a
determination by the manufacturer that the individual continues to meet the
eligibility requirements under par. (b).
4. If the manufacturer determines under subd. 1. or 2. that the individual is not
eligible for the patient assistance program, the manufacturer shall provide the
reason for the determination in the notification under subd. 1. or 2. The individual
may appeal the determination by filing an appeal with the commissioner that shall
include all of the information provided to the manufacturer under subds. 1. and 2.
The commissioner shall establish procedures for deciding appeals under this
subdivision. The commissioner shall issue a decision no later than 10 days after the
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appeal is filed, and the commissioner's decision shall be final. If the commissioner
determines that the individual meets the eligibility requirements under par. (b), the
manufacturer shall provide the individual with the statement of eligibility described
in subd. 3.
5. In the case of an individual who has prescription drug coverage through an
individual or group health plan, if the manufacturer determines under subd. 1. or 2.
that the individual is eligible for the patient assistance program but also determines
that the individual's insulin needs are better addressed through the use of the
manufacturer's copayment assistance program rather than the patient assistance
program, the manufacturer shall inform the individual of the determination and
provide the individual with the necessary coupons to submit to a pharmacy. The
individual may not be required to pay more than the copayment amount specified in
par. (d) 2.
(d) Provision of insulin under a patient assistance program. 1. Upon receipt
from an individual of the eligibility statement described in par. (c) 3. and a valid
insulin prescription, a pharmacy shall submit an order containing the name of the
insulin and daily dosage amount to the manufacturer. The pharmacy shall include
with the order the pharmacy's name, shipping address, office telephone number, fax
number, email address, and contact name, as well as any days or times when
deliveries are not accepted by the pharmacy.
2. Upon receipt of an order meeting the requirements under subd. 1., the
manufacturer shall send the pharmacy a 90-day supply of insulin, or lesser amount
if requested in the order, at no charge to the individual or pharmacy. The pharmacy
shall dispense the insulin to the individual associated with the order. The insulin
shall be dispensed at no charge to the individual, except that the pharmacy may
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collect a copayment from the individual to cover the pharmacy's costs for processing
and dispensing in an amount not to exceed $50 for each 90-day supply of insulin.
The pharmacy may not seek reimbursement from the manufacturer or a 3rd-party
payer.
3. The pharmacy may submit a reorder to the manufacturer if the individual's
eligibility statement described in par. (c) 3. has not expired. The reorder shall be
treated as an order for purposes of subd. 2.
4. Notwithstanding subds. 2. and 3., a manufacturer may send the insulin
directly to the individual if the manufacturer provides a mail-order service option,
in which case the pharmacy may not collect a copayment from the individual.
(4) EXCEPTIONS. (a) This section does not apply to a manufacturer that shows
to the commissioner's satisfaction that the manufacturer's annual gross revenue
from insulin sales in this state does not exceed $2,000,000.
(b) A manufacturer may not be required to make an insulin product available
under sub. (2) or (3) if the wholesale acquisition cost of the insulin product does not
exceed $8, as adjusted annually based on the U.S. consumer price index for all urban
consumers, U.S. city average, per milliliter or the applicable national council for
prescription drug programs' plan billing unit.
(5) CONFIDENTIALITY. All medical information solicited or obtained by any
person under this section shall be subject to the applicable provisions of state law
relating to confidentiality of medical information, including s. 610.70.
(6) REIMBURSEMENT PROHIBITION. No person, including a manufacturer,
pharmacy, pharmacist, or 3rd-party administrator, as part of participating in an
urgent need safety net program or patient assistance program may request or seek,
or cause another person to request or seek, any reimbursement or other
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compensation for which payment may be made in whole or in part under a federal
health care program, as defined in 42 USC 1320a-7b (f).
(7) REPORTS. (a) Annually, no later than March 1, each manufacturer shall
report to the commissioner all of the following information for the previous calendar
year:
1. The number of individuals who received insulin under the manufacturer's
urgent need safety net program.
2. The number of individuals who sought assistance under the manufacturer's
patient assistance program and the number of individuals who were determined to
be ineligible under sub. (3) (c) 4.
3. The wholesale acquisition cost of the insulin provided by the manufacturer
through the urgent need safety net program and patient assistance program.
(b) Annually, no later than April 1, the commissioner shall submit to the
governor and the chief clerk of each house of the legislature, for distribution to the
legislature under s. 13.172 (2), a report on the urgent need safety net programs and
patient assistance programs that includes all of the following:
1. The information provided to the commissioner under par. (a).
2. The penalties assessed under sub. (9) during the previous calendar year,
including the name of the manufacturer and amount of the penalty.
(8) ADDITIONAL RESPONSIBILITIES OF COMMISSIONER. (a) Application form. The
commissioner shall make the application form described in sub. (2) (c) 1. a. available
on the office's website and shall make the form available to pharmacies and health
care providers who prescribe or dispense insulin, hospital emergency departments,
urgent care clinics, and community health clinics.
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(b) Public outreach. 1. The commissioner shall conduct public outreach to
create awareness of the urgent need safety net programs and patient assistance
programs.
2. The commissioner shall develop and make available on the office's website
an information sheet that contains all of the following information:
a. A description of how to access insulin through an urgent need safety net
program.
b. A description of how to access insulin through a patient assistance program.
c. Information on how to contact a navigator for assistance in accessing insulin
through an urgent need safety net program or patient assistance program.
d. Information on how to contact the commissioner if a manufacturer
determines that an individual is not eligible for a patient assistance program.
e. A notification that an individual may contact the commissioner for more
information or assistance in accessing ongoing affordable insulin options.
(c) Navigators. The commissioner shall develop a training program to provide
navigators with information and the resources necessary to assist individuals in
accessing appropriate long-term insulin options. The commissioner shall compile
a list of navigators that have completed the training program and are available to
assist individuals in accessing affordable insulin coverage options. The list shall be
made available on the office's website and to pharmacies and health care
practitioners who dispense and prescribe insulin.
(d) Satisfaction surveys. 1. The commissioner shall develop and conduct a
satisfaction survey of individuals who have accessed insulin through urgent need
safety net programs and patient assistance programs. The survey shall ask whether
the individual is still in need of a long-term solution for affordable insulin and shall
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SECTION 17 ASSEMBLY BILL 748
include questions about the individual's satisfaction with all of the following, if
applicable:
a. Accessibility to urgent-need insulin.
b. Adequacy of the information sheet and list of navigators received from the
pharmacy.
c. Helpfulness of a navigator.
d. Ease of access in applying for a patient assistance program and receiving
insulin from the pharmacy under the patient assistance program.
2. The commissioner shall develop and conduct a satisfaction survey of
pharmacies that have dispensed insulin through urgent need safety net programs
and patient assistance programs. The survey shall include questions about the
pharmacy's satisfaction with all of the following, if applicable:
a. Timeliness of reimbursement from manufacturers for insulin dispensed by
the pharmacy under urgent need safety net programs.
b. Ease in submitting insulin orders to manufacturers.
c. Timeliness of receiving insulin orders from manufacturers.
3. The commissioner may contract with a nonprofit entity to develop and
conduct the surveys under subds. 1. and 2. and to evaluate the survey results.
4. No later than July 1, 2026, the commissioner shall submit to the governor
and the chief clerk of each house of the legislature, for distribution to the legislature
under s. 13.172 (2), a report on the results of the surveys under subds. 1. and 2.
(9) PENALTY. A manufacturer that fails to comply with this section may be
assessed a penalty of up to $200,000 per month of noncompliance, with the maximum
penalty increasing to $400,000 per month if the manufacturer continues to be in
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noncompliance after 6 months and increasing to $600,000 per month if the
manufacturer continues to be in noncompliance after one year.
SECTION 18. 632.869 of the statutes is created to read:
632.869 Reimbursement to federal drug pricing program participants.
(1) In this section:
(a) “Covered entity” means an entity described in 42 USC 256b (a) (4) (A), (D),
(E), (J), or (N) that participates in the federal drug pricing program under 42 USC
256b, a pharmacy of the entity, or a pharmacy contracted with the entity to dispense
drugs purchased through the federal drug pricing program under 42 USC 256b.
(b) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
(2) No person, including a pharmacy benefit manager and 3rd-party payer,
may do any of the following:
(a) Reimburse a covered entity for a drug that is subject to an agreement under
42 USC 256b at a rate lower than that paid for the same drug to pharmacies that are
not covered entities and have a similar prescription volume to that of the covered
entity.
(b) Assess a covered entity any fee, charge back, or other adjustment on the
basis of the covered entity's participation in the federal drug pricing program under
42 USC 256b.
SECTION 19. 632.895 (6) (title) of the statutes is amended to read:
632.895 (6) (title) EQUIPMENT AND SUPPLIES FOR TREATMENT OF DIABETES; INSULIN.
SECTION 20. 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
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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 21. 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).
2. Every disability insurance policy and self-insured health plan that covers
insulin and imposes 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 22.0Nonstatutory provisions.
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(1) CENTRALIZED DRUG REPOSITORY. The department of health services shall
study and implement a centralized physical drug repository program under s.
255.056.
(2) PRESCRIPTION DRUG IMPORTATION PROGRAM. The commissioner of insurance
shall submit the first report required under s. 601.575 (5) by the next January 1 or
July 1, whichever is earliest, that is at least 180 days after the date the prescription
drug importation program is fully operational under s. 601.575 (4). The
commissioner of insurance shall include in the first 3 reports submitted under s.
601.575 (5) information on the implementation of the audit functions under s.
601.575 (1) (n).
(3) PRESCRIPTION DRUG PURCHASING ENTITY. During the 2023-2025 fiscal
biennium, the office of the commissioner of insurance shall conduct a study on the
viability of creating or implementing a state prescription drug purchasing entity.
SECTION 23.0Effective date.
(1) COST-SHARING CAP ON INSULIN. The treatment of ss. 609.83 and 632.895 (6)
(title), the renumbering and amendment of s. 632.895 (6), and the creation of s.
632.895 (6) (b) take effect on the first day of the 4th month beginning after
publication.
(END)
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