Wisconsin 2023-2024 Regular Session

Wisconsin Senate Bill SB807 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	LRB-3877/1
2	2	JPC:cdc
3	3	2023 - 2024 LEGISLATURE
4	4	2023 SENATE BILL 807
5	5	December 12, 2023 - Introduced by Senators HESSELBEIN, L. JOHNSON, AGARD,
6	6	CARPENTER, SPREITZER, TAYLOR and WIRCH, cosponsored by Representatives
7	7	SUBECK, JOERS, C. ANDERSON, J. ANDERSON, ANDRACA, CONLEY, CONSIDINE,
8	8	EMERSON, JACOBSON, MADISON, MURSAU, ORTIZ-VELEZ, RATCLIFF, STUBBS and
9	9	SHANKLAND. Referred to Committee on Insurance and Small Business.
10	10	AN ACT to renumber 632.866 (1) (a); and to create 632.866 (1) (ag), 632.866 (1)
11	11	(cm) and 632.866 (2m) of the statutes; relating to: prohibiting step therapy
12	12	protocols for certain cancer drugs.
13	13	Analysis by the Legislative Reference Bureau
14	14	This bill prohibits an insurer, pharmacy benefit manager, or utilization review
15	15	organization from requiring a step therapy protocol for a drug that is prescribed for
16	16	metastatic cancer or a cancer-associated condition and the use of the drug is
17	17	approved by the federal Food and Drug Administration, consistent with best
18	18	practices for the treatment of metastatic cancer or the cancer-associated condition,
19	19	and supported by peer-reviewed publications that are based on evidence-based
20	20	research. A step therapy protocol, as defined in current law, establishes a specific
21	21	sequence in which medically appropriate prescription drugs are covered by a policy
22	22	or plan. Current law requires insurers, pharmacy benefit managers, and utilization
23	23	review organizations to use clinical review criteria for establishing a step therapy
24	24	protocol that are based on clinical practice guidelines that meet certain specific
25	25	criteria and to provide access to a process to request an exception to the step therapy
26	26	protocol.
27	27	The people of the state of Wisconsin, represented in senate and assembly, do
28	28	enact as follows:
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31	31	3 - 2 -2023 - 2024 Legislature LRB-3877/1
32	32	JPC:cdc
33	33	SECTION 1 SENATE BILL 807
34	34	SECTION 1. 632.866 (1) (a) of the statutes is renumbered 632.866 (1) (ar).
35	35	SECTION 2. 632.866 (1) (ag) of the statutes is created to read:
36	36	632.866 (1) (ag) “Cancer-associated condition” means any symptom or side
37	37	effect that is associated with metastatic cancer or the treatment of metastatic cancer
38	38	and that, in the judgment of a health care provider, further jeopardizes the health
39	39	of a patient if left untreated.
40	40	SECTION 3. 632.866 (1) (cm) of the statutes is created to read:
41	41	632.866 (1) (cm) “Metastatic cancer” means cancer that has spread from the
42	42	primary or original site of the cancer to nearby tissues, lymph nodes, or other areas
43	43	or parts of the body.
44	44	SECTION 4. 632.866 (2m) of the statutes is created to read:
45	45	632.866 (2m) STEP THERAPY PROTOCOL PROHIBITED. An insurer, pharmacy
46	46	benefit manager, or utilization review organization may not require a step therapy
47	47	protocol for a drug that is prescribed for metastatic cancer or a cancer-associated
48	48	condition and the use of the drug is all of the following:
49	49	(a) Approved by the federal food and drug administration.
50	50	(b) Consistent with best practices for the treatment of metastatic cancer or the
51	51	cancer-associated condition.
52	52	(c) Supported by peer-reviewed publications that are based on evidence-based
53	53	research.
54	54	(END)
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