| 1 | 1 | | 2025 - 2026 LEGISLATURE |
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| 2 | 2 | | LRB-1254/1 |
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| 3 | 3 | | JPC:emw |
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| 4 | 4 | | 2025 ASSEMBLY BILL 54 |
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| 5 | 5 | | February 24, 2025 - Introduced by Representatives NOVAK, GUNDRUM, B. |
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| 6 | 6 | | JACOBSON, MURSAU, SORTWELL, STEFFEN and TITTL, cosponsored by Senators |
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| 7 | 7 | | JAMES, CABRAL-GUEVARA and WANGGAARD. Referred to Committee on Health, |
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| 8 | 8 | | Aging and Long-Term Care. |
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| 9 | 9 | | |
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| 10 | 10 | | ***AUTHORS SUBJECT TO CHANGE*** |
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| 11 | 11 | | AN ACT to create 49.45 (9o) of the statutes; relating to: utilization |
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| 12 | 12 | | management controls for antipsychotic prescription drugs under the Medical |
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| 13 | 13 | | Assistance program. |
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| 14 | 14 | | Analysis by the Legislative Reference Bureau |
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| 15 | 15 | | This bill prohibits the Department of Health Services from imposing any |
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| 16 | 16 | | utilization management controls for prescription drugs under the Medical |
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| 17 | 17 | | Assistance program that are approved by the federal Food and Drug Administration |
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| 18 | 18 | | and are classified as antipsychotic. Utilization management controls are formal |
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| 19 | 19 | | techniques used by a health carrier or prescription drug utilization management |
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| 20 | 20 | | entity that are designed to evaluate prescription drug medical necessity, |
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| 21 | 21 | | appropriateness, efficacy, or efficiency. Currently, DHS administers the Medical |
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| 22 | 22 | | Assistance program, which is a joint federal and state program that provides health |
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| 23 | 23 | | services to individuals who have limited financial resources. |
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| 24 | 24 | | For further information see the state fiscal estimate, which will be printed as |
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| 25 | 25 | | an appendix to this bill. |
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| 26 | 26 | | The people of the state of Wisconsin, represented in senate and assembly, do |
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| 27 | 27 | | enact as follows: |
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| 28 | 28 | | 1 |
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| 29 | 29 | | 2 |
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| 30 | 30 | | 3 2025 - 2026 Legislature |
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| 31 | 31 | | ASSEMBLY BILL 54 |
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| 32 | 32 | | - 2 - LRB-1254/1 |
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| 33 | 33 | | JPC:emw |
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| 34 | 34 | | SECTION 1 |
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| 35 | 35 | | SECTION 1. 49.45 (9o) of the statutes is created to read: |
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| 36 | 36 | | 49.45 (9o) UTILIZATION MANAGEMENT CONTROLS FOR ANTIPSYCHOTIC |
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| 37 | 37 | | PRESCRIPTION DRUGS. (a) In this subsection: |
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| 38 | 38 | | 1. XPrescription drugY has the meaning given in s. 450.01 (20). |
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| 39 | 39 | | 2. XUtilization management controlsY means a set of formal techniques used |
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| 40 | 40 | | by a health carrier or prescription drug utilization management entity that are |
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| 41 | 41 | | designed to evaluate prescription drug medical necessity, appropriateness, efficacy, |
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| 42 | 42 | | or efficiency, including prior authorization and step therapy protocols. |
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| 43 | 43 | | (b) The department may not impose utilization management controls for any |
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| 44 | 44 | | prescription drug that is approved by the federal food and drug administration and |
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| 45 | 45 | | is classified as an antipsychotic. |
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| 46 | 46 | | (END) |
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