Wisconsin Senate Bill SB574

Wisconsin 2023-2024 Regular Session

• Introduced: 10/30/23
• Refer: 10/30/23
• Failed: 4/15/24

Caption

Cost-sharing cap on insulin.

Impact

If enacted, SB574 would significantly alter the financial landscape for individuals dependent on insulin. By instituting a fixed cost-sharing model, this bill aims to eliminate variable costs that can be prohibitive for many patients. Health insurance policies would no longer be allowed to impose any costs beyond the set cap, leading to potentially better adherence to medication regimens among diabetic patients. This reform may help reduce financial distress related to healthcare costs for those managing chronic conditions.

Summary

Senate Bill 574 is a legislative proposal aimed at capping the cost-sharing for insulin prescriptions to a maximum of $35 for a one-month supply. This bill applies to all health insurance policies and governmental self-insured health plans that cover insulin medications. The goal of the bill is to make insulin more affordable for individuals with diabetes, thereby addressing the rising costs associated with diabetes management. Currently, while health insurance policies must cover diabetes treatment costs, the exclusion and limitation provisions often make insulin burdensome for patients financially.

Contention

While the bill has garnered support from various health advocacy groups and patient rights organizations, there may be contention regarding its implications for insurance companies and the broader healthcare market. Critics could argue that such mandates could lead insurers to raise premiums or make adjustments to other aspects of their coverage to maintain profitability. Additionally, concerns may arise regarding the potential burden on self-insured health plans, which might face challenges in meeting the new financial requirements. The discussions around these points suggest a need for balanced stakeholder engagement to address any adverse effects on health plan financing.

Last_action

The bill has been referred to the Committee on Insurance and Small Business for further review and discussion.