2025 - 2026 LEGISLATURE
LRB-1254/1
JPC:emw
2025 ASSEMBLY BILL 54
February 24, 2025 - Introduced by Representatives NOVAK, GUNDRUM, B.
JACOBSON, MURSAU, SORTWELL, STEFFEN and TITTL, cosponsored by Senators
JAMES, CABRAL-GUEVARA and WANGGAARD. Referred to Committee on Health,
Aging and Long-Term Care.
***AUTHORS SUBJECT TO CHANGE***
AN ACT to create 49.45 (9o) of the statutes; relating to: utilization
management controls for antipsychotic prescription drugs under the Medical
Assistance program.
Analysis by the Legislative Reference Bureau
This bill prohibits the Department of Health Services from imposing any
utilization management controls for prescription drugs under the Medical
Assistance program that are approved by the federal Food and Drug Administration
and are classified as antipsychotic. Utilization management controls are formal
techniques used by a health carrier or prescription drug utilization management
entity that are designed to evaluate prescription drug medical necessity,
appropriateness, efficacy, or efficiency. Currently, DHS administers the Medical
Assistance program, which is a joint federal and state program that provides health
services to individuals who have limited financial resources.
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:
1
2
3 2025 - 2026 Legislature
ASSEMBLY BILL 54
- 2 - LRB-1254/1
JPC:emw
SECTION 1
SECTION 1. 49.45 (9o) of the statutes is created to read:
49.45 (9o) UTILIZATION MANAGEMENT CONTROLS FOR ANTIPSYCHOTIC
PRESCRIPTION DRUGS. (a) In this subsection:
1. XPrescription drugY has the meaning given in s. 450.01 (20).
2. XUtilization management controlsY means a set of formal techniques used
by a health carrier or prescription drug utilization management entity that are
designed to evaluate prescription drug medical necessity, appropriateness, efficacy,
or efficiency, including prior authorization and step therapy protocols.
(b) The department may not impose utilization management controls for any
prescription drug that is approved by the federal food and drug administration and
is classified as an antipsychotic.
(END)
1
2
3
4
5
6
7
8
9
10
11
12