LRB-1507/1
JPC:cdc
2023 - 2024 LEGISLATURE
2023 ASSEMBLY BILL 836
December 22, 2023 - Introduced by Representatives SUBECK, JOERS, C. ANDERSON,
J. ANDERSON, ANDRACA, CONLEY, CONSIDINE, EMERSON, JACOBSON, MADISON,
MURSAU, ORTIZ-VELEZ, RATCLIFF and STUBBS, cosponsored by Senators
HESSELBEIN, L. JOHNSON, AGARD, CARPENTER, SPREITZER, TAYLOR and WIRCH.
Referred to Committee on Health, Aging and Long-Term Care.
***AUTHORS SUBJECT TO CHANGE***
AN ACT to renumber 632.866 (1) (a); and to create 632.866 (1) (ag), 632.866 (1)
(cm) and 632.866 (2m) of the statutes; relating to: prohibiting step therapy
protocols for certain cancer drugs.
Analysis by the Legislative Reference Bureau
This bill prohibits an insurer, pharmacy benefit manager, or utilization review
organization from requiring a step therapy protocol for a drug that is prescribed for
metastatic cancer or a cancer-associated condition and the use of the drug is
approved by the federal Food and Drug Administration, consistent with best
practices for the treatment of metastatic cancer or the cancer-associated condition,
and supported by peer-reviewed publications that are based on evidence-based
research. A step therapy protocol, as defined in current law, establishes a specific
sequence in which medically appropriate prescription drugs are covered by a policy
or plan. Current law requires insurers, pharmacy benefit managers, and utilization
review organizations to use clinical review criteria for establishing a step therapy
protocol that are based on clinical practice guidelines that meet certain specific
criteria and to provide access to a process to request an exception to the step therapy
protocol.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
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3 - 2 -2023 - 2024 Legislature LRB-1507/1
JPC:cdc
SECTION 1 ASSEMBLY BILL 836
SECTION 1. 632.866 (1) (a) of the statutes is renumbered 632.866 (1) (ar).
SECTION 2. 632.866 (1) (ag) of the statutes is created to read:
632.866 (1) (ag) “Cancer-associated condition” means any symptom or side
effect that is associated with metastatic cancer or the treatment of metastatic cancer
and that, in the judgment of a health care provider, further jeopardizes the health
of a patient if left untreated.
SECTION 3. 632.866 (1) (cm) of the statutes is created to read:
632.866 (1) (cm) “Metastatic cancer” means cancer that has spread from the
primary or original site of the cancer to nearby tissues, lymph nodes, or other areas
or parts of the body.
SECTION 4. 632.866 (2m) of the statutes is created to read:
632.866 (2m) STEP THERAPY PROTOCOL PROHIBITED. An insurer, pharmacy
benefit manager, or utilization review organization may not require a step therapy
protocol for a drug that is prescribed for metastatic cancer or a cancer-associated
condition and the use of the drug is all of the following:
(a) Approved by the federal food and drug administration.
(b) Consistent with best practices for the treatment of metastatic cancer or the
cancer-associated condition.
(c) Supported by peer-reviewed publications that are based on evidence-based
research.
(END)
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