Wisconsin 2025-2026 Regular Session

Wisconsin Assembly Bill AB62 Compare Versions

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

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1	1	2025 - 2026 LEGISLATURE
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4	4	2025 ASSEMBLY BILL 62
5	5	February 24, 2025 - Introduced by Representatives SUBECK, SPAUDE, JOHNSON,
6	6	ANDERSON, ANDRACA, ARNEY, BARE, BILLINGS, BROWN, CRUZ, DESANTO,
7	7	DESMIDT, DOYLE, EMERSON, FITZGERALD, GOODWIN, HAYWOOD, HONG,
8	8	HYSELL, J. JACOBSON, JOERS, KIRSCH, MADISON, MAYADEV, MCCARVILLE,
9	9	MCGUIRE, MIRESSE, MOORE OMOKUNDE, NEUBAUER, ORTIZ-VELEZ, PALMERI,
10	10	PHELPS, PRADO, RIVERA-WAGNER, ROE, SHEEHAN, SINICKI, SNODGRASS,
11	11	STROUD, STUBBS, TAYLOR, TENORIO, UDELL and VINING, cosponsored by
12	12	Senators PFAFF, HESSELBEIN, DRAKE, CARPENTER, DASSLER-ALFHEIM,
13	13	HABUSH SINYKIN, L. JOHNSON, KEYESKI, RATCLIFF, ROYS, SMITH, SPREITZER,
14	14	WALL and WIRCH. Referred to Committee on Health, Aging and Long-Term
15	15	Care.
16	16
17	17	*AUTHORS SUBJECT TO CHANGE*
18	18	AN ACT to repeal 49.45 (18) (ag); to renumber and amend 632.895 (6); to
19	19	amend 49.45 (18) (ac), 609.83 and 632.895 (6) (title); to create 15.07 (3) (bm)
20	20	7., 15.735, 20.145 (1) (a), 20.145 (1) (g) 4., 49.45 (18) (b) 8., 255.056 (2g),
21	21	450.085 (3), 601.31 (1) (nv), 601.31 (1) (nw), 601.41 (14), 601.415 (14), 601.56,
22	22	601.57, 601.575, subchapter VI of chapter 601 [precedes 601.78], 632.865
23	23	(2m), 632.868, 632.869 and 632.895 (6) (b) of the statutes; relating to: health
24	24	care costs omnibus, granting rule-making authority, making an
25	25	appropriation, and providing a penalty.
26	26	Analysis by the Legislative Reference Bureau
27	27	Elimination of cost sharing for prescription drugs under the Medical
28	28	Assistance program
29	29	Under current law, certain persons who receive health services under the
30	30	Medical Assistance program, also known in this state as BadgerCare, are required
31	31	to contribute a cost-sharing payment to the cost of certain health services. This bill
32	32	eliminates all cost-sharing payments for prescription drugs under the Medical
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44	44	Assistance program. The Medical Assistance program is a joint state and federal
45	45	program that provides health services to individuals who have limited financial
46	46	resources.
47	47	Cost-sharing cap on insulin
48	48	The bill prohibits every health insurance policy and governmental self-insured
49	49	health plan that covers insulin and imposes cost sharing on prescription drugs from
50	50	imposing cost sharing on insulin in an amount that exceeds $35 for a one-month
51	51	supply. Current law requires every health insurance policy that provides coverage
52	52	of expenses incurred for treatment of diabetes to provide coverage for specified
53	53	expenses and items, including insulin. The required coverage under current law for
54	54	certain diabetes treatments other than insulin infusion pumps is subject to the
55	55	same exclusions, limitations, deductibles, and coinsurance provisions of the policy
56	56	as other covered expenses. The bill[s cost-sharing limitation on insulin supersedes
57	57	the specification that the exclusions, limitations, deductibles, and coinsurance are
58	58	the same as for other coverage.
59	59	Fiduciary and disclosure requirements for pharmacy benefit managers
60	60	The bill imposes fiduciary and disclosure requirements on pharmacy benefit
61	61	managers. Pharmacy benefit managers contract with health plans that provide
62	62	prescription drug benefits to administer those benefits for the plans. They also
63	63	have contracts with pharmacies and pay the pharmacies for providing drugs to the
64	64	plan beneficiaries.
65	65	The bill provides that a pharmacy benefit manager owes a fiduciary duty to a
66	66	health plan sponsor. The bill also requires that a pharmacy benefit manager
67	67	annually disclose all of the following information to the plan sponsor:
68	68	1. The indirect profit received by the pharmacy benefit manager from owning
69	69	a pharmacy or service provider.
70	70	2. Any payments made to a consultant or broker who works on behalf of the
71	71	plan sponsor.
72	72	3. From the amounts received from drug manufacturers, the amounts
73	73	retained by the pharmacy benefit manager that are related to the plan sponsor[s
74	74	claims or bona fide service fees.
75	75	4. The amounts received from network pharmacies and the amount retained
76	76	by the pharmacy benefit manager.
77	77	Reimbursements for certain 340B program entities
78	78	The bill prohibits any person from reimbursing certain entities that
79	79	participate in the federal drug pricing program, known as the 340B program, for a
80	80	drug subject to an agreement under the program at a rate lower than that paid for
81	81	the same drug to pharmacies that have a similar prescription volume. The bill also
82	82	prohibits a person from imposing any fee, charge back, or other adjustment on the
83	83	basis of the entity[s participation in the 340B program. The entities covered by the
84	84	prohibitions under the bill are federally qualified health centers, critical access
85	85	hospitals, and grantees under the federal Ryan White HIV/AIDS program, as well 2025 - 2026 Legislature
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89	89	as these entities[ pharmacies and any pharmacy with which any of the entities have
90	90	contracted to dispense drugs through the 340B program.
91	91	Drug repository program
92	92	Under current law, the Department of Health Services must maintain a drug
93	93	repository program under which any person may donate certain drugs or supplies
94	94	to be dispensed to and used by eligible individuals, prioritizing uninsured and
95	95	indigent individuals. The bill allows DHS to partner with out-of-state drug
96	96	repository programs. The bill also allows out-of-state persons to donate to the drug
97	97	repository program in Wisconsin and persons in Wisconsin to donate to
98	98	participating drug repository programs in other states. Further, the bill directs
99	99	DHS to study and implement a centralized, physical drug repository program.
100	100	Value-based diabetes medication pilot project
101	101	The bill directs the Office of the Commissioner of Insurance to develop a pilot
102	102	project under which a pharmacy benefit manager and pharmaceutical
103	103	manufacturer are directed to create a value-based, sole-source arrangement to
104	104	reduce the costs of prescription diabetes medication. The bill allows OCI to
105	105	promulgate rules to implement the pilot project.
106	106	Pharmacist continuing education credits for volunteering at free and
107	107	charitable clinics
108	108	Under current law, a licensed pharmacist must renew his or her license every
109	109	two years. An applicant for renewal of a pharmacist license must submit proof that
110	110	he or she has completed 30 hours of continuing education within the two-year
111	111	period immediately preceding the date of his or her application. The bill allows
112	112	pharmacists to meet up to 10 hours of the continuing education requirement for
113	113	each two-year period by volunteering at a free and charitable clinic approved by the
114	114	Pharmacy Examining Board.
115	115	Prescription drug importation program
116	116	The bill requires the commissioner of insurance, in consultation with persons
117	117	interested in the sale and pricing of prescription drugs and federal officials and
118	118	agencies, to design and implement a prescription drug importation program for the
119	119	benefit of and that generates savings for Wisconsin residents. The bill establishes
120	120	requirements for the program, including all of the following:
121	121	1. The commissioner must designate a state agency to become a licensed
122	122	wholesale distributor or contract with a licensed wholesale distributor and to seek
123	123	federal certification and approval to import prescription drugs.
124	124	2. The program must comply with certain federal regulations and import from
125	125	Canadian suppliers only prescription drugs that are not brand-name drugs, have
126	126	fewer than four competitor drugs in this country, and for which importation creates
127	127	substantial savings.
128	128	3. The commissioner must ensure that prescription drugs imported under the
129	129	program are not distributed, dispensed, or sold outside of Wisconsin. 2025 - 2026 Legislature
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133	133	4. The program must have an audit procedure to ensure the program complies
134	134	with certain requirements specified in the bill.
135	135	Before submitting the proposed program to the federal government for
136	136	certification, the commissioner must submit the proposed program to the Joint
137	137	Committee on Finance for its approval.
138	138	Pharmacy benefits tool grants
139	139	The bill directs OCI to award grants in an amount of up to $500,000 in each
140	140	fiscal year to health care providers to develop and implement a patient pharmacy
141	141	benefits tool that would allow prescribers to disclose the cost of prescription drugs
142	142	for patients. The tool must be usable by physicians and other prescribers to
143	143	determine the cost of prescription drugs for their patients. Any health care
144	144	provider that receives a grant to develop and implement a patient pharmacy
145	145	benefits tool is required to contribute matching funds equal to at least 50 percent of
146	146	the total grant awarded.
147	147	Prescription drug purchasing entity study
148	148	The bill requires OCI to conduct a study on the viability of creating or
149	149	implementing a state prescription drug purchasing entity.
150	150	Licensure of pharmacy services administrative organizations
151	151	The bill requires that a pharmacy services administrative organization
152	152	(PSAO) be licensed by OCI. Under the bill, a PSAO is an entity operating in
153	153	Wisconsin that does all of the following:
154	154	1. Contracts with an independent pharmacy to conduct business on the
155	155	pharmacy[s behalf with a third-party payer.
156	156	2. Provides at least one administrative service to an independent pharmacy
157	157	and negotiates and enters into a contract with a third-party payer or pharmacy
158	158	benefit manager on the pharmacy[s behalf.
159	159	The bill defines Xindependent pharmacyY to mean a licensed pharmacy
160	160	operating in Wisconsin that is under common ownership with no more than two
161	161	other pharmacies. XAdministrative serviceY is defined to mean assisting with
162	162	claims or audits, providing centralized payment, performing certification in a
163	163	specialized care program, providing compliance support, setting flat fees for generic
164	164	drugs, assisting with store layout, managing inventory, providing marketing
165	165	support, providing management and analysis of payment and drug dispensing data,
166	166	or providing resources for retail cash cards. The bill defines Xthird-party payerY to
167	167	mean an entity operating in Wisconsin that pays or insures health, medical, or
168	168	prescription drug expenses on behalf of beneficiaries. The bill uses the current law
169	169	definition of Xpharmacy benefit manager,Y which is an entity doing business in
170	170	Wisconsin that contracts to administer or manage prescription drug benefits on
171	171	behalf of an insurer or other entity that provides prescription drug benefits to
172	172	Wisconsin residents.
173	173	To obtain the license required by the bill, a person must apply to OCI and
174	174	provide the contact information for the applicant and a contact person, evidence of 2025 - 2026 Legislature
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178	178	financial responsibility of at least $1,000,000, and any other information required
179	179	by the commissioner by rule. Under the bill, the license fee is set by the
180	180	commissioner, and the term of a license is two years.
181	181	The bill also requires that a PSAO disclose to OCI the extent of any ownership
182	182	or control by an entity that provides pharmacy services; provides prescription drug
183	183	or device services; or manufactures, sells, or distributes prescription drugs,
184	184	biologicals, or medical devices. The PSAO must notify OCI within five days of any
185	185	material change in its ownership or control related to such an entity.
186	186	Licensure of pharmaceutical representatives
187	187	The bill requires a pharmaceutical representative to be licensed by OCI and to
188	188	display the pharmaceutical representative[s license during each visit with a health
189	189	care professional. The bill defines Xpharmaceutical representativeY to mean an
190	190	individual who markets or promotes pharmaceuticals to health care professionals
191	191	on behalf of a pharmaceutical manufacturer for compensation.
192	192	The term of a license issued under the bill is one year, and the license is
193	193	renewable. The application to obtain or renew a license must include the
194	194	applicant[s contact information, a description of the type of work in which the
195	195	applicant will engage, the license fee, an attestation that professional education
196	196	requirements are met, proof that any penalties and other fees are paid, and any
197	197	other information required by OCI by rule. Under the bill, the license fee is set by
198	198	the commissioner. The bill requires the pharmaceutical representative to report,
199	199	within four business days, any change to the information provided on the
200	200	application or any material change to the pharmaceutical representative[s business
201	201	operations or other information required to be reported under the bill.
202	202	The bill requires that a pharmaceutical representative complete a professional
203	203	education course prior to becoming licensed and to annually complete at least five
204	204	hours of continuing professional education courses. The coursework must include,
205	205	at a minimum, training in ethical standards, whistleblower protections, and the
206	206	laws and rules applicable to pharmaceutical marketing. The bill directs the
207	207	commissioner to regularly publish a list of courses that fulfill the education
208	208	requirements. Under the bill, a course provider must disclose any conflict of
209	209	interest to the commissioner, and the courses may not be provided by the employer
210	210	of a pharmaceutical representative or be funded by the pharmaceutical industry or
211	211	a third party funded by the industry.
212	212	The bill requires that, no later than June 1 of each year, a pharmaceutical
213	213	representative report to OCI the pharmaceutical representative[s total number of
214	214	contacts with health care professionals in Wisconsin, the specialties of those health
215	215	care professionals, the location and duration of each contact, the pharmaceuticals
216	216	discussed, and the value of any item provided to a health care professional. The bill
217	217	directs the commissioner to publish the information on OCI[s website without
218	218	identifying individual health care professionals.
219	219	The bill requires that a pharmaceutical representative, during each contact
220	220	with a health care professional, disclose the wholesale acquisition cost of any 2025 - 2026 Legislature
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224	224	pharmaceuticals discussed and the names of at least three generic prescription
225	225	drugs from the same therapeutic class.
226	226	The bill directs the commissioner to promulgate ethical standards for
227	227	pharmaceutical representatives. Additionally, the bill prohibits a pharmaceutical
228	228	representative from engaging in deceptive or misleading marketing of a
229	229	pharmaceutical product; using a title or designation that could reasonably lead a
230	230	licensed health care professional, or an employee or representative of such a
231	231	professional, to believe that the pharmaceutical representative is licensed to
232	232	practice in a health occupation unless the pharmaceutical representative holds a
233	233	license to practice in that health occupation; or attending a patient examination
234	234	without the patient[s consent.
235	235	An individual who violates any of the requirements under the bill is subject to
236	236	a forfeiture, and the individual[s license may be suspended or revoked. An
237	237	individual whose license is revoked must wait at least two years before applying for
238	238	a new license.
239	239	Insulin safety net programs
240	240	The bill requires insulin manufacturers to establish a program under which
241	241	qualifying Wisconsin residents who are in urgent need of insulin and are uninsured
242	242	or have limited insurance coverage can be dispensed insulin at a pharmacy. An
243	243	individual is in urgent need of insulin if the individual needs insulin in order to
244	244	avoid the likelihood of suffering a significant health consequence and possesses less
245	245	than a seven-day supply of insulin readily available for use. Under the program, if
246	246	a qualifying individual in urgent need of insulin provides a pharmacy with a form
247	247	attesting that the individual meets the program[s eligibility requirements, specified
248	248	proof of residency, and a valid insulin prescription, the pharmacy must dispense a
249	249	30-day supply of insulin to the individual and may charge the individual a
250	250	copayment of no more than $35. The pharmacy may submit an electronic payment
251	251	claim for the insulin[s acquisition cost to the manufacturer or agree to receive a
252	252	replacement of the same insulin in the amount dispensed.
253	253	The bill also requires that each insulin manufacturer establish a patient
254	254	assistance program to make insulin available to any qualifying Wisconsin resident
255	255	who, among other requirements, is uninsured or has limited insurance coverage
256	256	and whose family income does not exceed 400 percent of the federal poverty line.
257	257	Under the bill, an individual must apply to participate in a manufacturer[s
258	258	program. If the manufacturer determines that the individual meets the program[s
259	259	eligibility requirements, the manufacturer must issue the individual a statement of
260	260	eligibility, which is valid for 12 months and may be renewed. Under the bill, if an
261	261	individual with a statement of eligibility and valid insulin prescription requests
262	262	insulin from a pharmacy, the pharmacy must submit an order to the manufacturer,
263	263	who must then provide a 90-day supply of insulin at no charge to the individual or
264	264	pharmacy. The pharmacy may charge the individual a copayment of no more than
265	265	$50. Under the bill, a manufacturer is not required to issue a statement of
266	266	eligibility if the individual has prescription drug coverage through an individual or 2025 - 2026 Legislature
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270	270	group health plan and the manufacturer determines that the individual[s insulin
271	271	needs are better addressed through the manufacturer[s copayment assistance
272	272	program. In such case, the manufacturer must provide the individual with
273	273	necessary drug coupons to submit to a pharmacy, and the individual may not be
274	274	required to pay more than a $50 copayment for a 90-day supply of insulin.
275	275	Under the bill, if the manufacturer determines that an individual is not
276	276	eligible for the patient assistance program, the individual may file an appeal with
277	277	OCI. The bill directs OCI to establish procedures for deciding appeals. Under the
278	278	bill, OCI must issue a decision within 10 days, and that decision is final.
279	279	The bill requires that insulin manufacturers annually report to OCI certain
280	280	information, including the number of individuals served and the cost of insulin
281	281	dispensed under the programs and that OCI annually report to the governor and
282	282	the legislature on the programs. The bill also directs OCI to conduct public
283	283	outreach and develop an information sheet about the programs, conduct
284	284	satisfaction surveys of individuals and pharmacies that participate in the
285	285	programs, and report to the governor and the legislature on the surveys by July 1,
286	286	2028. Additionally, the bill requires that OCI develop a training program for health
287	287	care navigators to assist individuals in accessing appropriate long-term insulin
288	288	options and maintain a list of trained navigators.
289	289	The bill provides that a manufacturer that fails to comply with the bill[s
290	290	provisions may be assessed a forfeiture of up to $200,000 per month of
291	291	noncompliance, which increases to $400,000 per month if the manufacturer
292	292	continues to be in noncompliance after six months and to $600,000 per month if the
293	293	manufacturer continues to be in noncompliance after one year. The bill [s
294	294	requirements do not apply to manufacturers with annual insulin sales revenue in
295	295	Wisconsin of no more than $2,000,000 or to insulin that costs less than a specified
296	296	dollar amount.
297	297	Prescription Drug Affordability Review Board
298	298	The bill creates a Prescription Drug Affordability Review Board, whose
299	299	purpose is to protect Wisconsin residents and other stakeholders from the high
300	300	costs of prescription drugs. The board consists of the commissioner of insurance
301	301	and the following members, all of whom are appointed by the governor for four-year
302	302	terms:
303	303	1. Two members who represent the pharmaceutical drug industry, at least
304	304	one of whom is a licensed pharmacist.
305	305	2. Two members who represent the health insurance industry.
306	306	3. Two members who represent the health care industry, at least one of whom
307	307	is a licensed practitioner.
308	308	4. Two members who represent the interests of the public.
309	309	The bill requires the board to meet in open session at least four times per year
310	310	to review prescription drug pricing information. The board must provide at least
311	311	two weeks[ public notice of each meeting, make the meeting[s materials publicly
312	312	available at least one week prior to the meeting, and provide the opportunity for 2025 - 2026 Legislature
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316	316	public comment. The bill imposes conflict of interest requirements for the board
317	317	relating to recusal and public disclosure of certain conflicts. The bill directs the
318	318	board to access and assess drug pricing information, to the extent practicable, by
319	319	accessing and assessing information from other states, by assessing spending for
320	320	the drug in Wisconsin, and by accessing other available pricing information.
321	321	Under the bill, the board must conduct drug cost affordability reviews. The
322	322	board must identify prescription drugs whose launch wholesale acquisition cost
323	323	exceeds specified thresholds, prescription drugs whose increase in wholesale
324	324	acquisition cost exceeds specified thresholds, and other prescription drugs that may
325	325	create affordability challenges for the health care system in Wisconsin. For each
326	326	identified prescription drug, the board must determine whether to conduct an
327	327	affordability review by seeking stakeholder input and considering the average
328	328	patient cost share for the drug. During an affordability review, the board must
329	329	determine whether use of the prescription drug that is fully consistent with the
330	330	labeling approved by the federal Food and Drug Administration or standard
331	331	medical practice has led or will lead to an affordability challenge for the health care
332	332	system in Wisconsin. In making this determination, the bill requires the board to
333	333	consider a variety of factors, which include the following:
334	334	1. The drug[s wholesale acquisition cost.
335	335	2. The average monetary price concession, discount, or rebate the
336	336	manufacturer provides, or is expected to provide, for the drug to health plans.
337	337	3. The total amount of price concessions, discounts, and rebates the
338	338	manufacturer provides to each pharmacy benefit manager for the drug.
339	339	4. The price at which therapeutic alternatives have been sold and the average
340	340	monetary concession, discount, or rebate the manufacturer provides, or is expected
341	341	to provide, to health plan payors and pharmacy benefit managers for therapeutic
342	342	alternatives.
343	343	5. The costs to health plans based on patient access consistent with federal
344	344	labeled indications and recognized standard medical practice.
345	345	6. The impact on patient access resulting from the drug[s cost relative to
346	346	insurance benefit design.
347	347	7. The current or expected dollar value of drug-specific patient access
348	348	programs that are supported by the manufacturer.
349	349	8. The relative financial impacts to health, medical, or social services costs
350	350	that can be quantified and compared to baseline effects of existing therapeutic
351	351	alternatives.
352	352	9. The average patient copay or other cost sharing for the drug.
353	353	If the board determines that a prescription drug will lead to an affordability
354	354	challenge, the bill directs the board to establish an upper payment limit for that
355	355	drug that applies to all purchases and payor reimbursements of the drug dispensed
356	356	or administered to individuals in Wisconsin. In establishing the upper payment
357	357	limit, the board must consider the cost of administering the drug, the cost of
358	358	delivering it to consumers, and other relevant administrative costs. For certain 2025 - 2026 Legislature
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362	362	SECTION 1
363	363	drugs, the board must solicit information from the manufacturer regarding the
364	364	price increase and, if the board determines that the price increase is not a result of
365	365	the need for increased manufacturing capacity or other effort to improve patient
366	366	access during a public health emergency, the board must establish an upper
367	367	payment limit equal to the drug[s cost prior to the price increase.
368	368	Further, this bill provides $500,000 in program revenue in fiscal year 2026]27
369	369	for onetime implementation costs associated with establishing an Office of
370	370	Prescription Drug Affordability in OCI. The bill provides that the Office of
371	371	Prescription Drug Affordability is responsible for prescription drug affordability
372	372	programming within OCI and for overseeing the operations of the Prescription
373	373	Drug Affordability Review Board. Additionally, the bill authorizes and funds for
374	374	fiscal year 2026]27 16.0 positions for the Office of Prescription Drug Affordability.
375	375	Finally, the bill credits to the appropriation account for OCI[s general program
376	376	operations all moneys received from the regulation of pharmacy benefit managers,
377	377	pharmacy benefit management brokers, pharmacy benefit management
378	378	consultants, pharmacy services administrative organizations, and pharmaceutical
379	379	sales representatives.
380	380	This proposal may contain a health insurance mandate requiring a social and
381	381	financial impact report under s. 601.423, stats.
382	382	For further information see the state fiscal estimate, which will be printed as
383	383	an appendix to this bill.
384	384	The people of the state of Wisconsin, represented in senate and assembly, do
385	385	enact as follows:
386	386	SECTION 1. 15.07 (3) (bm) 7. of the statutes is created to read:
387	387	15.07 (3) (bm) 7. The prescription drug affordability review board shall meet
388	388	at least 4 times each year.
389	389	SECTION 2. 15.735 of the statutes is created to read:
390	390	15.735 Same; attached board. (1) There is created a prescription drug
391	391	affordability review board attached to the office of the commissioner of insurance
392	392	under s. 15.03. The board shall consist of the following members:
393	393	(a) The commissioner of insurance or his or her designee.
394	394	(b) Two members appointed for 4-year terms who represent the
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407	407	SECTION 2
408	408	pharmaceutical drug industry, including pharmaceutical drug manufacturers and
409	409	wholesalers. At least one of the members appointed under this paragraph shall be
410	410	a pharmacist licensed in this state.
411	411	(c) Two members appointed for 4-year terms who represent the health
412	412	insurance industry, including insurers and pharmacy benefit managers.
413	413	(d) Two members appointed for 4-year terms who represent the health care
414	414	industry, including hospitals, physicians, pharmacies, and pharmacists. At least
415	415	one of the members appointed under this paragraph shall be a licensed health care
416	416	practitioner.
417	417	(e) Two members appointed for 4-year terms who represent the interests of
418	418	the public.
419	419	(2) A member appointed under sub. (1), except for a member appointed under
420	420	sub. (1) (b), may not be an employee of, a board member of, or a consultant to a drug
421	421	manufacturer or trade association for drug manufacturers.
422	422	(3) Any conflict of interest, including any financial or personal association,
423	423	that has the potential to bias or has the appearance of biasing an individual[s
424	424	decision in matters related to the board or the conduct of the board[s activities shall
425	425	be considered and disclosed when appointing that individual to the board under
426	426	sub. (1).
427	427	SECTION 3. 20.005 (3) (schedule) of the statutes: at the appropriate place,
428	428	insert the following amounts for the purposes indicated:
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449	449	21 2025 - 2026 Legislature
450	450	ASSEMBLY BILL 62
451	451	- 11 - LRB-1302/1
452	452	JPC:all
453	453	SECTION 3
454	454	2025-26 2026-27
455	455	20.145 Insurance, office of the commissioner of
456	456	(1) SUPERVISION OF THE INSURANCE INDUSTRY
457	457	(a) State operations GPR A -0- 500,000
458	458	SECTION 4. 20.145 (1) (a) of the statutes is created to read:
459	459	20.145 (1) (a) State operations. The amounts in the schedule for general
460	460	program operations.
461	461	SECTION 5. 20.145 (1) (g) 4. of the statutes is created to read:
462	462	20.145 (1) (g) 4. All moneys received from the regulation of pharmacy benefit
463	463	managers, pharmacy benefit management brokers, pharmacy benefit management
464	464	consultants, pharmacy services administrative organizations, and pharmaceutical
465	465	sales representatives.
466	466	SECTION 6. 49.45 (18) (ac) of the statutes is amended to read:
467	467	49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag),
468	468	any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the
469	469	benefits under s. 49.46 (2) (a) and (b) under s. 49.471, shall pay up to the maximum
470	470	amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services
471	471	provided under s. 49.46 (2). The service provider shall collect the specified or
472	472	allowable copayment, coinsurance, or deductible, unless the service provider
473	473	determines that the cost of collecting the copayment, coinsurance, or deductible
474	474	exceeds the amount to be collected. The department shall reduce payments to each
475	475	provider by the amount of the specified or allowable copayment, coinsurance, or
476	476	deductible. No provider may deny care or services because the recipient is unable to
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499	499	23 2025 - 2026 Legislature
500	500	ASSEMBLY BILL 62
501	501	- 12 - LRB-1302/1
502	502	JPC:all
503	503	SECTION 6
504	504	share costs, but an inability to share costs specified in this subsection does not
505	505	relieve the recipient of liability for these costs.
506	506	SECTION 7. 49.45 (18) (ag) of the statutes is repealed.
507	507	SECTION 8. 49.45 (18) (b) 8. of the statutes is created to read:
508	508	49.45 (18) (b) 8. Prescription drugs.
509	509	SECTION 9. 255.056 (2g) of the statutes is created to read:
510	510	255.056 (2g) The department may partner with out-of-state drug repository
511	511	programs. The department may authorize a medical facility or pharmacy that
512	512	elects to participate in the drug repository program to receive drugs or supplies
513	513	from out of state, and the department may authorize an out-of-state entity that
514	514	participates in a partner out-of-state drug repository program to receive drugs or
515	515	supplies from Wisconsin.
516	516	SECTION 10. 450.085 (3) of the statutes is created to read:
517	517	450.085 (3) An applicant for renewal of a license under s. 450.08 (2) (a) may
518	518	count, for purposes of the continuing education requirement under sub. (1), up to 10
519	519	hours spent as a volunteer at a free and charitable clinic approved by the board.
520	520	SECTION 11. 601.31 (1) (nv) of the statutes is created to read:
521	521	601.31 (1) (nv) For issuing or renewing a license as a pharmaceutical
522	522	representative under s. 601.56, an amount to be set by the commissioner by rule.
523	523	SECTION 12. 601.31 (1) (nw) of the statutes is created to read:
524	524	601.31 (1) (nw) For issuing or renewing a license as a pharmacy services
525	525	administrative organization under s. 601.57, an amount to be set by the
526	526	commissioner by rule.
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549	549	23 2025 - 2026 Legislature
550	550	ASSEMBLY BILL 62
551	551	- 13 - LRB-1302/1
552	552	JPC:all
553	553	SECTION 13
554	554	SECTION 13. 601.41 (14) of the statutes is created to read:
555	555	601.41 (14) VALUE-BASED DIABETES MEDICATION PILOT PROJECT. The
556	556	commissioner shall develop a pilot project to direct a pharmacy benefit manager, as
557	557	defined in s. 632.865 (1) (c), and a pharmaceutical manufacturer to create a value-
558	558	based, sole-source arrangement to reduce the costs of prescription medication used
559	559	to treat diabetes. The commissioner may promulgate rules to implement this
560	560	subsection.
561	561	SECTION 14. 601.415 (14) of the statutes is created to read:
562	562	601.415 (14) PATIENT PHARMACY BENEFITS TOOL. (a) From the appropriation
563	563	under s. 20.145 (1) (a), beginning in the 2026-27 fiscal year, the office shall award
564	564	grants in a total amount of up to $500,000 each fiscal year to health care providers
565	565	to develop and implement a tool for prescribers to disclose the cost of prescription
566	566	drugs for patients. The tool must be usable by physicians and other prescribers to
567	567	determine the cost of prescription drugs for their patients.
568	568	(b) Any health care provider that receives a grant under par. (a) shall
569	569	contribute matching funds equal to at least 50 percent of the grant amount
570	570	awarded.
571	571	SECTION 15. 601.56 of the statutes is created to read:
572	572	601.56 Pharmaceutical representatives. (1) DEFINITIONS. In this
573	573	section:
574	574	(a) XHealth care professionalY means a physician or other health care
575	575	practitioner who is licensed to provide health care services or to prescribe
576	576	pharmaceutical or biologic products.
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599	599	23 2025 - 2026 Legislature
600	600	ASSEMBLY BILL 62
601	601	- 14 - LRB-1302/1
602	602	JPC:all
603	603	SECTION 15
604	604	(b) XPharmaceuticalY means a medication that may legally be dispensed only
605	605	with a valid prescription from a health care professional.
606	606	(c) XPharmaceutical representativeY means an individual who markets or
607	607	promotes pharmaceuticals to health care professionals on behalf of a
608	608	pharmaceutical manufacturer for compensation.
609	609	(d) XWholesale acquisition costY means the most recently reported
610	610	manufacturer list or catalog price for a brand-name or generic drug available to
611	611	wholesalers or direct purchasers in the United States, before application of
612	612	discounts, rebates, or reductions in price.
613	613	(2) LICENSURE. (a) No individual may act as a pharmaceutical representative
614	614	in this state without being licensed by the commissioner as a pharmaceutical
615	615	representative under this section. In order to obtain or renew a license, the
616	616	individual shall apply to the commissioner in the form and manner prescribed by
617	617	the commissioner. The term of a license issued under this paragraph is one year
618	618	and is renewable. The application to obtain or renew a license shall include all of
619	619	the following information:
620	620	1. The applicant[s full name, residence address and telephone number, and
621	621	business address and telephone number.
622	622	2. A description of the type of work in which the applicant will engage.
623	623	3. The fee under s. 601.31 (1) (nv).
624	624	4. An attestation that the applicant meets the professional education
625	625	requirements under sub. (3).
626	626	5. Proof that the applicant has paid any assessed penalties and fees.
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649	649	23 2025 - 2026 Legislature
650	650	ASSEMBLY BILL 62
651	651	- 15 - LRB-1302/1
652	652	JPC:all
653	653	SECTION 15
654	654	6. Any other information required by the commissioner by rule.
655	655	(b) The pharmaceutical representative licensed under par. (a) shall notify the
656	656	commissioner in writing of any change to the information submitted on an
657	657	application under par. (a) or any material change to the pharmaceutical
658	658	representative[s business operations or to any other information provided under
659	659	this section. The pharmaceutical representative shall provide the notification no
660	660	later than 4 business days after the change or material change occurs.
661	661	(c) A pharmaceutical representative licensed under par. (a) shall display the
662	662	pharmaceutical representative[s license during each visit with a health care
663	663	professional.
664	664	(3) PROFESSIONAL EDUCATION REQUIREMENTS . (a) In order to become initially
665	665	licensed under sub. (2) (a), a pharmaceutical representative shall complete a
666	666	professional education course approved by the commissioner. A pharmaceutical
667	667	representative shall, upon request, provide the commissioner with proof that he or
668	668	she has completed an approved professional education course.
669	669	(b) In order to renew a license under sub. (2) (a), a pharmaceutical
670	670	representative shall complete a minimum of 5 hours of continuing professional
671	671	education courses. A pharmaceutical representative who has renewed a license
672	672	under sub. (2) (a) shall, upon request, provide the commissioner with proof that he
673	673	or she has completed a minimum of 5 hours of continuing professional education
674	674	courses.
675	675	(c) The professional education coursework required under pars. (a) and (b)
676	676	shall include training in ethical standards, whistleblower protections, laws and
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699	699	23 2025 - 2026 Legislature
700	700	ASSEMBLY BILL 62
701	701	- 16 - LRB-1302/1
702	702	JPC:all
703	703	SECTION 15
704	704	rules applicable to pharmaceutical marketing, and other subjects that the
705	705	commissioner identifies by rule.
706	706	(d) The commissioner shall regularly designate courses that fulfill the
707	707	requirements under this subsection and publish a list of the designated courses.
708	708	(e) The professional education coursework required under this subsection may
709	709	not be provided by the employer of a pharmaceutical representative or be funded, in
710	710	any way, by the pharmaceutical industry or a 3rd party funded by the
711	711	pharmaceutical industry. A provider of a course designated under par. (d) shall
712	712	disclose any conflict of interest to the commissioner.
713	713	(4) DISCLOSURE TO COMMISSIONER. (a) No later than June 1 of each year, a
714	714	pharmaceutical representative licensed under sub. (2) (a) shall provide to the
715	715	commissioner, in the manner prescribed by the commissioner, all of the following
716	716	information from the previous calendar year:
717	717	1. The total number of times the pharmaceutical representative contacted
718	718	health care professionals in this state and the specialties of the health care
719	719	professionals contacted.
720	720	2. For each contact with a health care professional in this state, the location
721	721	and duration of the contact, the pharmaceuticals for which the pharmaceutical
722	722	representative provided information, and the value of any item, including a product
723	723	sample, compensation, material, or gift, provided to the health care professional.
724	724	(b) The commissioner shall publish the information received under par. (a) on
725	725	the commissioner[s website in a manner in which individual health care
726	726	professionals are not identifiable by name or other identifiers.
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750	750	ASSEMBLY BILL 62
751	751	- 17 - LRB-1302/1
752	752	JPC:all
753	753	SECTION 15
754	754	(5) DISCLOSURE TO HEALTH CARE PROFESSIONALS. During each contact with a
755	755	health care professional, a pharmaceutical representative licensed under sub. (2)
756	756	(a) shall disclose the wholesale acquisition cost of any pharmaceutical for which the
757	757	pharmaceutical representative provides information and the names of at least 3
758	758	generic prescription drugs from the same therapeutic class or, if 3 are not available,
759	759	as many as are available for prescriptive use.
760	760	(6) ETHICAL STANDARDS. The commissioner shall promulgate rules that
761	761	contain ethical standards for pharmaceutical representatives and shall publish the
762	762	ethical standards on the commissioner[s website. A pharmaceutical representative
763	763	licensed under sub. (2) (a) shall comply with the ethical standards contained in the
764	764	rules and may not do any of the following:
765	765	(a) Engage in deceptive or misleading marketing of a pharmaceutical,
766	766	including the knowing concealment, suppression, omission, misleading
767	767	representation, or misstatement of a material fact.
768	768	(b) Use a title or designation that could reasonably lead a licensed health care
769	769	professional, or an employee or representative of a licensed health care professional,
770	770	to believe that the pharmaceutical representative is licensed to practice medicine,
771	771	nursing, dentistry, optometry, pharmacy, or other similar health occupation in this
772	772	state unless the pharmaceutical representative holds that license to practice.
773	773	(c) Attend a patient examination without the patient[s consent.
774	774	(7) ENFORCEMENT . (a) Any individual who violates this section shall be
775	775	required to forfeit not less than $1,000 nor more than $3,000 for each offense. Each
776	776	day of continued violation constitutes a separate offense.
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799	799	23 2025 - 2026 Legislature
800	800	ASSEMBLY BILL 62
801	801	- 18 - LRB-1302/1
802	802	JPC:all
803	803	SECTION 15
804	804	(b) The commissioner may suspend or revoke the license of a pharmaceutical
805	805	representative who violates this section. A suspended or revoked license may not be
806	806	reinstated until the pharmaceutical representative remedies all violations related
807	807	to the suspension or revocation and pays all assessed penalties and fees. A
808	808	pharmaceutical representative whose license is revoked for any cause may not be
809	809	issued a license under sub. (2) (a) until at least 2 years after the date of revocation.
810	810	(c) A health care professional who meets with a pharmaceutical
811	811	representative who does not display the pharmaceutical representative[s license or
812	812	share the information required under sub. (5) may report the pharmaceutical
813	813	representative to the commissioner.
814	814	(8) RULES. The commissioner may promulgate rules to implement this
815	815	section.
816	816	SECTION 16. 601.57 of the statutes is created to read:
817	817	601.57 Pharmacy services administrative organizations . (1)
818	818	DEFINITIONS. In this section:
819	819	(a) XAdministrative serviceY means any of the following:
820	820	1. Assisting with claims.
821	821	2. Assisting with audits.
822	822	3. Providing centralized payment.
823	823	4. Performing certification in a specialized care program.
824	824	5. Providing compliance support.
825	825	6. Setting flat fees for generic drugs.
826	826	7. Assisting with store layout.
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849	849	23 2025 - 2026 Legislature
850	850	ASSEMBLY BILL 62
851	851	- 19 - LRB-1302/1
852	852	JPC:all
853	853	SECTION 16
854	854	8. Managing inventory.
855	855	9. Providing marketing support.
856	856	10. Providing management and analysis of payment and drug dispensing
857	857	data.
858	858	11. Providing resources for retail cash cards.
859	859	(b) XIndependent pharmacyY means a pharmacy operating in this state that is
860	860	licensed under s. 450.06 or 450.065 and is under common ownership with no more
861	861	than 2 other pharmacies.
862	862	(c) XPharmacy benefit managerY has the meaning given in s. 632.865 (1) (c).
863	863	(d) XPharmacy services administrative organizationY means an entity
864	864	operating in this state that does all of the following:
865	865	1. Contracts with an independent pharmacy to conduct business on the
866	866	independent pharmacy[s behalf with a 3rd-party payer.
867	867	2. Provides at least one administrative service to an independent pharmacy
868	868	and negotiates and enters into a contract with a 3rd-party payer or pharmacy
869	869	benefit manager on behalf of the independent pharmacy.
870	870	(e) XThird-party payerY means an entity, including a plan sponsor, health
871	871	maintenance organization, or insurer, operating in this state that pays or insures
872	872	health, medical, or prescription drug expenses on behalf of beneficiaries.
873	873	(2) LICENSURE. (a) No person may operate as a pharmacy services
874	874	administrative organization in this state without being licensed by the
875	875	commissioner as a pharmacy services administrative organization under this
876	876	section. In order to obtain or renew a license, the person shall apply to the
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899	899	23 2025 - 2026 Legislature
900	900	ASSEMBLY BILL 62
901	901	- 20 - LRB-1302/1
902	902	JPC:all
903	903	SECTION 16
904	904	commissioner in the form and manner prescribed by the commissioner. The
905	905	application shall include all of the following:
906	906	1. The name, address, telephone number, and federal employer identification
907	907	number of the applicant.
908	908	2. The name, business address, and telephone number of a contact person for
909	909	the applicant.
910	910	3. The fee under s. 601.31 (1) (nw).
911	911	4. Evidence of financial responsibility of at least $1,000,000.
912	912	5. Any other information required by the commissioner by rule.
913	913	(b) The term of a license issued under par. (a) shall be 2 years from the date of
914	914	issuance.
915	915	(3) DISCLOSURE TO THE COMMISSIONER. (a) A pharmacy services
916	916	administrative organization licensed under sub. (2) shall disclose to the
917	917	commissioner the extent of any ownership or control of the pharmacy services
918	918	administrative organization by an entity that does any of the following:
919	919	1. Provides pharmacy services.
920	920	2. Provides prescription drug or device services.
921	921	3. Manufactures, sells, or distributes prescription drugs, biologicals, or
922	922	medical devices.
923	923	(b) A pharmacy services administrative organization licensed under sub. (2)
924	924	shall notify the commissioner in writing within 5 days of any material change in its
925	925	ownership or control relating to an entity described in par. (a).
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948	948	ASSEMBLY BILL 62
949	949	- 21 - LRB-1302/1
950	950	JPC:all
951	951	SECTION 16
952	952	(4) RULES. The commissioner may promulgate rules to implement this
953	953	section.
954	954	SECTION 17. 601.575 of the statutes is created to read:
955	955	601.575 Prescription drug importation program. (1) IMPORTATION
956	956	PROGRAM REQUIREMENTS . The commissioner, in consultation with persons
957	957	interested in the sale and pricing of prescription drugs and appropriate officials
958	958	and agencies of the federal government, shall design and implement a prescription
959	959	drug importation program for the benefit of residents of this state, that generates
960	960	savings for residents, and that satisfies all of the following:
961	961	(a) The commissioner shall designate a state agency to become a licensed
962	962	wholesale distributor or to contract with a licensed wholesale distributor and shall
963	963	seek federal certification and approval to import prescription drugs.
964	964	(b) The program shall comply with relevant requirements of 21 USC 384,
965	965	including safety and cost savings requirements.
966	966	(c) The program shall import prescription drugs from Canadian suppliers
967	967	regulated under any appropriate Canadian or provincial laws.
968	968	(d) The program shall have a process to sample the purity, chemical
969	969	composition, and potency of imported prescription drugs.
970	970	(e) The program shall import only those prescription drugs for which
971	971	importation creates substantial savings for residents of this state and only those
972	972	prescription drugs that are not brand-name drugs and that have fewer than 4
973	973	competitor prescription drugs in the United States.
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996	996	ASSEMBLY BILL 62
997	997	- 22 - LRB-1302/1
998	998	JPC:all
999	999	SECTION 17
1000	1000	(f) The commissioner shall ensure that prescription drugs imported under the
1001	1001	program are not distributed, dispensed, or sold outside of this state.
1002	1002	(g) The program shall ensure all of the following:
1003	1003	1. Participation by any pharmacy or health care provider in the program is
1004	1004	voluntary.
1005	1005	2. Any pharmacy or health care provider participating in the program has the
1006	1006	appropriate license or other credential in this state.
1007	1007	3. Any pharmacy or health care provider participating in the program charges
1008	1008	a consumer or health plan the actual acquisition cost of the imported prescription
1009	1009	drug that is dispensed.
1010	1010	(h) The program shall ensure that a payment by a health plan or health
1011	1011	insurance policy for a prescription drug imported under the program reimburses no
1012	1012	more than the actual acquisition cost of the imported prescription drug that is
1013	1013	dispensed.
1014	1014	(i) The program shall ensure that any health plan or health insurance policy
1015	1015	participating in the program does all of the following:
1016	1016	1. Maintains a formulary and claims payment system with current
1017	1017	information on prescription drugs imported under the program.
1018	1018	2. Bases cost-sharing amounts for participants or insureds under the plan or
1019	1019	policy on no more than the actual acquisition cost of the prescription drug imported
1020	1020	under the program that is dispensed to the participant or insured.
1021	1021	3. Demonstrates to the commissioner or a state agency designated by the
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1047	1047	SECTION 17
1048	1048	commissioner how premiums under the plan or policy are affected by savings on
1049	1049	prescription drugs imported under the program.
1050	1050	(j) Any wholesale distributor importing prescription drugs under the program
1051	1051	shall limit its profit margin to the amount established by the commissioner or a
1052	1052	state agency designated by the commissioner.
1053	1053	(k) The program may not import any generic prescription drug that would
1054	1054	violate federal patent laws on branded products in the United States.
1055	1055	(L) The program shall comply with tracking and tracing requirements of 21
1056	1056	USC 360eee and 360eee-1, to the extent practical and feasible, before the
1057	1057	prescription drug to be imported comes into the possession of this state[s wholesale
1058	1058	distributor and fully after the prescription drug to be imported is in the possession
1059	1059	of this state[s wholesale distributor.
1060	1060	(m) The program shall establish a fee or other mechanism to finance the
1061	1061	program that does not jeopardize significant savings to residents of this state.
1062	1062	(n) The program shall have an audit function that ensures all of the following:
1063	1063	1. The commissioner has a sound methodology to determine the most cost-
1064	1064	effective prescription drugs to include in the program.
1065	1065	2. The commissioner has a process in place to select Canadian suppliers that
1066	1066	are high quality, high performing, and in full compliance with Canadian laws.
1067	1067	3. Prescription drugs imported under the program are pure, unadulterated,
1068	1068	potent, and safe.
1069	1069	4. The program is complying with the requirements of this subsection.
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1096	1096	5. The program is adequately financed to support administrative functions of
1097	1097	the program while generating significant cost savings to residents of this state.
1098	1098	6. The program does not put residents of this state at a higher risk than if the
1099	1099	program did not exist.
1100	1100	7. The program provides and is projected to continue to provide substantial
1101	1101	cost savings to residents of this state.
1102	1102	(2) ANTICOMPETITIVE BEHAVIOR. The commissioner, in consultation with the
1103	1103	attorney general, shall identify the potential for and monitor anticompetitive
1104	1104	behavior in industries affected by a prescription drug importation program.
1105	1105	(3) APPROVAL OF PROGRAM DESIGN; CERTIFICATION. No later than the first day
1106	1106	of the 7th month beginning after the effective date of this subsection .... [LRB
1107	1107	inserts date], the commissioner shall submit to the joint committee on finance a
1108	1108	report that includes the design of the prescription drug importation program in
1109	1109	accordance with this section. The commissioner may not submit the proposed
1110	1110	program to the federal department of health and human services unless the joint
1111	1111	committee on finance approves the proposed program. Within 14 days of the date of
1112	1112	approval by the joint committee on finance of the proposed program, the
1113	1113	commissioner shall submit to the federal department of health and human services
1114	1114	a request for certification of the approved program.
1115	1115	(4) IMPLEMENTATION OF CERTIFIED PROGRAM. After the federal department of
1116	1116	health and human services certifies the prescription drug importation program
1117	1117	submitted under sub. (3), the commissioner shall begin implementation of the
1118	1118	program, and the program shall be fully operational by 180 days after the date of
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1145	1145	SECTION 17
1146	1146	certification by the federal department of health and human services. The
1147	1147	commissioner shall do all of the following to implement the program to the extent
1148	1148	the action is in accordance with other state laws and the certification by the federal
1149	1149	department of health and human services:
1150	1150	(a) Become a licensed wholesale distributor, designate another state agency to
1151	1151	become a licensed wholesale distributor, or contract with a licensed wholesale
1152	1152	distributor.
1153	1153	(b) Contract with one or more Canadian suppliers that meet the criteria in
1154	1154	sub. (1) (c) and (n).
1155	1155	(c) Create an outreach and marketing plan to communicate with and provide
1156	1156	information to health plans and health insurance policies, employers, pharmacies,
1157	1157	health care providers, and residents of this state on participating in the program.
1158	1158	(d) Develop and implement a registration process for health plans and health
1159	1159	insurance policies, pharmacies, and health care providers interested in
1160	1160	participating in the program.
1161	1161	(e) Create a publicly accessible source for listing prices of prescription drugs
1162	1162	imported under the program.
1163	1163	(f) Create, publicize, and implement a method of communication to promptly
1164	1164	answer questions from and address the needs of persons affected by the
1165	1165	implementation of the program before the program is fully operational.
1166	1166	(g) Establish the audit functions under sub. (1) (n) with a timeline to complete
1167	1167	each audit function every 2 years.
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1194	1194	(h) Conduct any other activities determined by the commissioner to be
1195	1195	important to successful implementation of the program.
1196	1196	(5) REPORT. By January 1 and July 1 of each year, the commissioner shall
1197	1197	submit to the joint committee on finance a report including all of the following:
1198	1198	(a) A list of prescription drugs included in the prescription drug importation
1199	1199	program under this section.
1200	1200	(b) The number of pharmacies, health care providers, and health plans and
1201	1201	health insurance policies participating in the prescription drug importation
1202	1202	program under this section.
1203	1203	(c) The estimated amount of savings to residents of this state, health plans
1204	1204	and health insurance policies, and employers resulting from the implementation of
1205	1205	the prescription drug importation program under this section reported from the
1206	1206	date of the previous report under this subsection and from the date the program
1207	1207	was fully operational.
1208	1208	(d) Findings of any audit functions under sub. (1) (n) completed since the date
1209	1209	of the previous report under this subsection.
1210	1210	(6) RULE MAKING. The commissioner may promulgate any rules necessary to
1211	1211	implement this section.
1212	1212	SECTION 18. Subchapter VI of chapter 601 [precedes 601.78] of the statutes is
1213	1213	created to read:
1214	1214	CHAPTER 601
1215	1215	SUBCHAPTER VI
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1241	1241	SECTION 18
1242	1242	PRESCRIPTION DRUG
1243	1243	AFFORDABILITY REVIEW BOARD
1244	1244	601.78 Definitions. In this subchapter:
1245	1245	(1) XBiologicY means a drug that is produced or distributed in accordance with
1246	1246	a biologics license application approved under 21 CFR 601.20.
1247	1247	(2) XBiosimilarY means a drug that is produced or distributed in accordance
1248	1248	with a biologics license application approved under 42 USC 262 (k) (3).
1249	1249	(3) XBoardY means the prescription drug affordability review board
1250	1250	established under s. 15.735 (1).
1251	1251	(4) XBrand name drugY means a drug that is produced or distributed in
1252	1252	accordance with an original new drug application approved under 21 USC 355 (c),
1253	1253	other than an authorized generic drug, as defined in 42 CFR 447.502.
1254	1254	(5) XDrug productY means a brand name drug, a generic drug, a biologic, a
1255	1255	biosimilar, or an over-the-counter drug.
1256	1256	(6) XFinancial benefitY includes an honorarium, a fee, a stock, the value of the
1257	1257	stock holdings of a member of the board or any immediate family member, and any
1258	1258	direct financial benefit deriving from the finding of a review conducted under s.
1259	1259	601.79.
1260	1260	(7) XGeneric drugY means any of the following:
1261	1261	(a) A retail drug that is marketed or distributed in accordance with an
1262	1262	abbreviated new drug application approved under 21 USC 355 (j).
1263	1263	(b) An authorized generic drug, as defined in 42 CFR 447.502.
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1290	1290	(c) A drug that entered the market prior to 1962 and was not originally
1291	1291	marketed under a new drug application.
1292	1292	(8) XImmediate family memberY means a spouse, grandparent, parent,
1293	1293	sibling, child, stepchild, or grandchild or the spouse of a grandparent, parent,
1294	1294	sibling, child, stepchild, or grandchild.
1295	1295	(9) XManufacturerY means an entity that does all of the following:
1296	1296	(a) Engages in the manufacture of a drug product or enters into a lease with
1297	1297	another manufacturer to market and distribute a prescription drug product under
1298	1298	the entity[s own name.
1299	1299	(b) Sets or changes the wholesale acquisition cost of the drug product or
1300	1300	prescription drug product described in par. (a).
1301	1301	(10) XOver-the-counter drugY means a drug intended for human use that does
1302	1302	not require a prescription and meets the requirements of 21 CFR parts 328 to 369.
1303	1303	(11) XPharmacy benefit managerY has the meaning given in s. 632.865 (1) (c).
1304	1304	(12) XPrescription drug productY means a brand name drug, a generic drug, a
1305	1305	biologic, or a biosimilar.
1306	1306	601.785 Prescription drug affordability review board. (1) MISSION.
1307	1307	The purpose of the board is to protect state residents, the state, local governments,
1308	1308	health plans, health care providers, pharmacies licensed in this state, and other
1309	1309	stakeholders of the health care system in this state from the high costs of
1310	1310	prescription drug products.
1311	1311	(2) POWERS AND DUTIES. (a) The board shall do all of the following:
1312	1312	1. Meet in open session at least 4 times per year to review prescription drug
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1339	1339	SECTION 18
1340	1340	product pricing information, except that the chair may cancel or postpone a meeting
1341	1341	if there is no business to transact.
1342	1342	2. To the extent practicable, access and assess pricing information for
1343	1343	prescription drug products by doing all of the following:
1344	1344	a. Accessing and assessing information from other states by entering into
1345	1345	memoranda of understanding with other states to which manufacturers report
1346	1346	pricing information.
1347	1347	b. Assessing spending for specific prescription drug products in this state.
1348	1348	c. Accessing other available pricing information.
1349	1349	(b) The board may do any of the following:
1350	1350	1. Promulgate rules for the administration of this subchapter.
1351	1351	2. Enter into a contract with an independent 3rd party for any service
1352	1352	necessary to carry out the powers and duties of the board as described in this
1353	1353	subsection. Unless written permission is granted by the board, a person with whom
1354	1354	the board contracts may not release, publish, or otherwise use any information to
1355	1355	which the person has access under the contract.
1356	1356	(c) The board shall establish and maintain a website to provide public notices
1357	1357	and make meeting materials available under sub. (3) (a) and to disclose conflicts of
1358	1358	interest under sub. (4) (d).
1359	1359	(3) MEETING REQUIREMENTS . (a) Pursuant to s. 19.84, the board shall provide
1360	1360	public notice of each board meeting at least 2 weeks prior to the meeting and shall
1361	1361	make the materials for each meeting publicly available at least one week prior to
1362	1362	the meeting.
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1390	1390	(b) Notwithstanding s. 19.84 (2), the board shall provide an opportunity for
1391	1391	public comment at each open meeting and shall provide the public with the
1392	1392	opportunity to provide written comments on pending decisions of the board.
1393	1393	(c) Notwithstanding subch. V of ch. 19, any portion of a meeting of the board
1394	1394	concerning proprietary data and information shall be conducted in closed session
1395	1395	and shall in all respects remain confidential.
1396	1396	(d) The board may allow expert testimony at any meeting, including when the
1397	1397	board meets in closed session.
1398	1398	(4) CONFLICTS OF INTEREST. (a) A member of the board shall recuse himself
1399	1399	or herself from a decision by the board relating to a prescription drug product if the
1400	1400	member or an immediate family member has received or could receive any of the
1401	1401	following:
1402	1402	1. A direct financial benefit deriving from a determination, or a finding of a
1403	1403	study or review, by the board relating to the prescription drug product.
1404	1404	2. A financial benefit in excess of $5,000 in a calendar year from any person
1405	1405	who owns, manufactures, or provides a prescription drug product to be studied or
1406	1406	reviewed by the board.
1407	1407	(b) A conflict of interest under this subsection shall be disclosed by the board
1408	1408	when hiring board staff, by the appointing authority when appointing members to
1409	1409	the board, and by the board when a member of the board is recused from any
1410	1410	decision relating to a review of a prescription drug product.
1411	1411	(c) A conflict of interest under this subsection shall be disclosed no later than
1412	1412	5 days after the conflict is identified, except that, if the conflict is identified within
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1439	1439	SECTION 18
1440	1440	5 days of an open meeting of the board, the conflict shall be disclosed prior to the
1441	1441	meeting.
1442	1442	(d) The board shall disclose a conflict of interest under this subsection on the
1443	1443	board[s website unless the chair of the board recuses the member from a final
1444	1444	decision relating to a review of the prescription drug product. The disclosure shall
1445	1445	include the type, nature, and magnitude of the interests of the member involved.
1446	1446	(e) A member of the board or a 3rd-party contractor may not accept any gift or
1447	1447	donation of services or property that indicates a potential conflict of interest or has
1448	1448	the appearance of biasing the work of the board.
1449	1449	601.79 Drug cost affordability review. (1) IDENTIFICATION OF DRUGS.
1450	1450	The board shall identify prescription drug products that are any of the following:
1451	1451	(a) A brand name drug or biologic that, as adjusted annually to reflect
1452	1452	adjustments to the U.S. consumer price index for all urban consumers, U.S. city
1453	1453	average, as determined by the U.S. department of labor, has a launch wholesale
1454	1454	acquisition cost of at least $30,000 per year or course of treatment.
1455	1455	(b) A brand name drug or biologic that, as adjusted annually to reflect
1456	1456	adjustments to the U.S. consumer price index for all urban consumers, U.S. city
1457	1457	average, as determined by the U.S. department of labor, has a wholesale acquisition
1458	1458	cost that has increased at least $3,000 during a 12-month period.
1459	1459	(c) A biosimilar that has a launch wholesale acquisition cost that is not 15
1460	1460	percent or more lower than the referenced brand biologic at the time the biosimilar
1461	1461	is launched.
1462	1462	(d) A generic drug that has a wholesale acquisition cost, as adjusted annually
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1489	1489	SECTION 18
1490	1490	to reflect adjustments to the U.S. consumer price index for all urban consumers,
1491	1491	U.S. city average, as determined by the U.S. department of labor, that meets all of
1492	1492	the following conditions:
1493	1493	1. Is at least $100 for a supply lasting a patient for a period of 30 consecutive
1494	1494	days based on the recommended dosage approved for labeling by the federal food
1495	1495	and drug administration, a supply lasting a patient for a period of fewer than 30
1496	1496	days based on the recommended dosage approved for labeling by the federal food
1497	1497	and drug administration, or one unit of the drug if the labeling approved by the
1498	1498	federal food and drug administration does not recommend a finite dosage.
1499	1499	2. Increased by at least 200 percent during the preceding 12-month period, as
1500	1500	determined by the difference between the resulting wholesale acquisition cost and
1501	1501	the average of the wholesale acquisition cost reported over the preceding 12
1502	1502	months.
1503	1503	(e) Other prescription drug products, including drugs to address public health
1504	1504	emergencies, that may create affordability challenges for the health care system
1505	1505	and patients in this state.
1506	1506	(2) AFFORDABILITY REVIEW. (a) After identifying prescription drug products
1507	1507	under sub. (1), the board shall determine whether to conduct an affordability
1508	1508	review for each identified prescription drug product by seeking stakeholder input
1509	1509	about the prescription drug product and considering the average patient cost share
1510	1510	of the prescription drug product.
1511	1511	(b) The information used to conduct an affordability review under par. (a) may
1512	1512	include any document and research related to the manufacturer[s selection of the
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1539	1539	SECTION 18
1540	1540	introductory price or price increase of the prescription drug product, including life
1541	1541	cycle management, net average price in this state, market competition and context,
1542	1542	projected revenue, and the estimated value or cost-effectiveness of the prescription
1543	1543	drug product.
1544	1544	(c) The failure of a manufacturer to provide the board with information for an
1545	1545	affordability review under par. (b) does not affect the authority of the board to
1546	1546	conduct the review.
1547	1547	(3) AFFORDABILITY CHALLENGE. When conducting an affordability review of a
1548	1548	prescription drug product under sub. (2), the board shall determine whether use of
1549	1549	the prescription drug product that is fully consistent with the labeling approved by
1550	1550	the federal food and drug administration or standard medical practice has led or
1551	1551	will lead to an affordability challenge for the health care system in this state,
1552	1552	including high out-of-pocket costs for patients. To the extent practicable, in
1553	1553	determining whether a prescription drug product has led or will lead to an
1554	1554	affordability challenge, the board shall consider all of the following factors:
1555	1555	(a) The wholesale acquisition cost for the prescription drug product sold in
1556	1556	this state.
1557	1557	(b) The average monetary price concession, discount, or rebate the
1558	1558	manufacturer provides, or is expected to provide, to health plans in this state as
1559	1559	reported by manufacturers and health plans, expressed as a percentage of the
1560	1560	wholesale acquisition cost for the prescription drug product under review.
1561	1561	(c) The total amount of the price concessions, discounts, and rebates the
1562	1562	manufacturer provides to each pharmacy benefit manager for the prescription drug
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1586	1586	ASSEMBLY BILL 62
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1588	1588	JPC:all
1589	1589	SECTION 18
1590	1590	product under review, as reported by the manufacturer and pharmacy benefit
1591	1591	manager and expressed as a percentage of the wholesale acquisition cost.
1592	1592	(d) The price at which therapeutic alternatives to the prescription drug
1593	1593	product have been sold in this state.
1594	1594	(e) The average monetary concession, discount, or rebate the manufacturer
1595	1595	provides or is expected to provide to health plan payors and pharmacy benefit
1596	1596	managers in this state for therapeutic alternatives to the prescription drug product.
1597	1597	(f) The costs to health plans based on patient access consistent with labeled
1598	1598	indications by the federal food and drug administration and recognized standard
1599	1599	medical practice.
1600	1600	(g) The impact on patient access resulting from the cost of the prescription
1601	1601	drug product relative to insurance benefit design.
1602	1602	(h) The current or expected dollar value of drug-specific patient access
1603	1603	programs that are supported by the manufacturer.
1604	1604	(i) The relative financial impacts to health, medical, or social services costs
1605	1605	that can be quantified and compared to baseline effects of existing therapeutic
1606	1606	alternatives to the prescription drug product.
1607	1607	(j) The average patient copay or other cost sharing for the prescription drug
1608	1608	product in this state.
1609	1609	(k) Any information a manufacturer chooses to provide.
1610	1610	(L) Any other factors as determined by the board by rule.
1611	1611	(4) UPPER PAYMENT LIMIT. (a) If the board determines under sub. (3) that use
1612	1612	of a prescription drug product has led or will lead to an affordability challenge, the
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1636	1636	ASSEMBLY BILL 62
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1638	1638	JPC:all
1639	1639	SECTION 18
1640	1640	board shall establish an upper payment limit for the prescription drug product after
1641	1641	considering all of the following:
1642	1642	1. The cost of administering the drug.
1643	1643	2. The cost of delivering the drug to consumers.
1644	1644	3. Other relevant administrative costs related to the drug.
1645	1645	(b) For a prescription drug product identified in sub. (1) (b) or (d) 2., the board
1646	1646	shall solicit information from the manufacturer regarding the price increase. To
1647	1647	the extent that the price increase is not a result of the need for increased
1648	1648	manufacturing capacity or other effort to improve patient access during a public
1649	1649	health emergency, the board shall establish an upper payment limit under par. (a)
1650	1650	that is equal to the cost to consumers prior to the price increase.
1651	1651	(c) 1. An upper payment limit established under par. (a) shall apply to all
1652	1652	purchases and payor reimbursements of the prescription drug product dispensed or
1653	1653	administered to individuals in this state in person, by mail, or by other means.
1654	1654	2. Notwithstanding subd. 1., while state-sponsored and state-regulated
1655	1655	health plans and health programs shall limit drug reimbursements and drug
1656	1656	payment to no more than the upper payment limit established under par. (a), a plan
1657	1657	subject to the Employee Retirement Income Security Act of 1974 or Part D of
1658	1658	Medicare under 42 USC 1395w-101 et seq. may choose to reimburse more than the
1659	1659	upper payment limit. A provider who dispenses and administers a prescription
1660	1660	drug product in this state to an individual in this state may not bill a payor more
1661	1661	than the upper payment limit to the patient regardless of whether a plan subject to
1662	1662	the Employee Retirement Income Security Act of 1974 or Part D of Medicare under
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1686	1686	ASSEMBLY BILL 62
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1688	1688	JPC:all
1689	1689	SECTION 18
1690	1690	42 USC 1395w-101 et seq. chooses to reimburse the provider above the upper
1691	1691	payment limit.
1692	1692	(5) PUBLIC INSPECTION. Information submitted to the board under this
1693	1693	section shall be open to public inspection only as provided under ss. 19.31 to 19.39.
1694	1694	(6) NO PROHIBITION ON MARKETING. Nothing in this section may be construed
1695	1695	to prevent a manufacturer from marketing a prescription drug product approved by
1696	1696	the federal food and drug administration while the prescription drug product is
1697	1697	under review by the board.
1698	1698	(7) APPEALS. A person aggrieved by a decision of the board may request an
1699	1699	appeal of the decision no later than 30 days after the board makes the
1700	1700	determination. The board shall hear the appeal and make a final decision no later
1701	1701	than 60 days after the appeal is requested. A person aggrieved by a final decision of
1702	1702	the board may petition for judicial review in a court of competent jurisdiction.
1703	1703	SECTION 19. 609.83 of the statutes is amended to read:
1704	1704	609.83 Coverage of drugs and devices. Limited service health
1705	1705	organizations, preferred provider plans, and defined network plans are subject to
1706	1706	ss. 632.853, 632.861, and 632.895 (6) (b), (16t), and (16v).
1707	1707	SECTION 20. 632.865 (2m) of the statutes is created to read:
1708	1708	632.865 (2m) FIDUCIARY DUTY AND DISCLOSURES TO HEALTH BENEFIT PLAN
1709	1709	SPONSORS. (a) A pharmacy benefit manager owes a fiduciary duty to the health
1710	1710	benefit plan sponsor to act according to the health benefit plan sponsor[s
1711	1711	instructions and in the best interests of the health benefit plan sponsor.
1712	1712	(b) A pharmacy benefit manager shall annually provide, no later than the
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1736	1736	ASSEMBLY BILL 62
1737	1737	- 37 - LRB-1302/1
1738	1738	JPC:all
1739	1739	SECTION 20
1740	1740	date and using the method prescribed by the commissioner by rule, the health
1741	1741	benefit plan sponsor all of the following information from the previous calendar
1742	1742	year:
1743	1743	1. The indirect profit received by the pharmacy benefit manager from owning
1744	1744	any interest in a pharmacy or service provider.
1745	1745	2. Any payment made by the pharmacy benefit manager to a consultant or
1746	1746	broker who works on behalf of the health benefit plan sponsor.
1747	1747	3. From the amounts received from all drug manufacturers, the amounts
1748	1748	retained by the pharmacy benefit manager, and not passed through to the health
1749	1749	benefit plan sponsor, that are related to the health benefit plan sponsor[s claims or
1750	1750	bona fide service fees.
1751	1751	4. The amounts, including pharmacy access and audit recovery fees, received
1752	1752	from all pharmacies that are in the pharmacy benefit manager[s network or have a
1753	1753	contract to be in the network and, from these amounts, the amount retained by the
1754	1754	pharmacy benefit manager and not passed through to the health benefit plan
1755	1755	sponsor.
1756	1756	SECTION 21. 632.868 of the statutes is created to read:
1757	1757	632.868 Insulin safety net programs. (1) DEFINITIONS. In this section:
1758	1758	(a) XManufacturerY means a person engaged in the manufacturing of insulin
1759	1759	that is self-administered on an outpatient basis.
1760	1760	(b) XNavigatorY has the meaning given in s. 628.90 (3).
1761	1761	(c) XPatient assistance programY means a program established by a
1762	1762	manufacturer under sub. (3) (a).
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1786	1786	ASSEMBLY BILL 62
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1788	1788	JPC:all
1789	1789	SECTION 21
1790	1790	(d) XPharmacyY means an entity licensed under s. 450.06 or 450.065.
1791	1791	(e) XUrgent need of insulinY means having less than a 7-day supply of insulin
1792	1792	readily available for use and needing insulin in order to avoid the likelihood of
1793	1793	suffering a significant health consequence.
1794	1794	(f) XUrgent need safety net programY means a program established by a
1795	1795	manufacturer under sub. (2) (a).
1796	1796	(2) URGENT NEED SAFETY NET PROGRAM. (a) Establishment of program. No
1797	1797	later than July 1, 2026, each manufacturer shall establish an urgent need safety net
1798	1798	program to make insulin available in accordance with this subsection to individuals
1799	1799	who meet the eligibility requirements under par. (b).
1800	1800	(b) Eligible individual. An individual shall be eligible to receive insulin under
1801	1801	an urgent need safety net program if all of the following conditions are met:
1802	1802	1. The individual is in urgent need of insulin.
1803	1803	2. The individual is a resident of this state.
1804	1804	3. The individual is not receiving public assistance under ch. 49.
1805	1805	4. The individual is not enrolled in prescription drug coverage through an
1806	1806	individual or group health plan that limits the total cost sharing amount, including
1807	1807	copayments, deductibles, and coinsurance, that an enrollee is required to pay for a
1808	1808	30-day supply of insulin to no more than $75, regardless of the type or amount of
1809	1809	insulin prescribed.
1810	1810	5. The individual has not received insulin under an urgent need safety net
1811	1811	program within the previous 12 months, except as allowed under par. (d).
1812	1812	(c) Provision of insulin under an urgent need safety net program. 1. In order
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1836	1836	ASSEMBLY BILL 62
1837	1837	- 39 - LRB-1302/1
1838	1838	JPC:all
1839	1839	SECTION 21
1840	1840	to receive insulin under an urgent need safety net program, an individual who
1841	1841	meets the eligibility requirements under par. (b) shall provide a pharmacy with all
1842	1842	of the following:
1843	1843	a. A completed application, on a form prescribed by the commissioner that
1844	1844	shall include an attestation by the individual, or the individual[s parent or legal
1845	1845	guardian if the individual is under the age of 18, that the individual meets all of the
1846	1846	eligibility requirements under par. (b).
1847	1847	b. A valid insulin prescription.
1848	1848	c. A valid Wisconsin driver[s license or state identification card. If the
1849	1849	individual is under the age of 18, the individual[s parent or legal guardian shall
1850	1850	meet this requirement.
1851	1851	2. Upon receipt of the information described in subd. 1. a. to c., the pharmacist
1852	1852	shall dispense a 30-day supply of the prescribed insulin to the individual. The
1853	1853	pharmacy shall also provide the individual with the information sheet described in
1854	1854	sub. (8) (b) 2. and the list of navigators described in sub. (8) (c). The pharmacy may
1855	1855	collect a copayment, not to exceed $35, from the individual to cover the pharmacy[s
1856	1856	costs of processing and dispensing the insulin. The pharmacy shall notify the
1857	1857	health care practitioner who issued the prescription no later than 72 hours after the
1858	1858	insulin is dispensed.
1859	1859	3. A pharmacy that dispenses insulin under subd. 2. may submit to the
1860	1860	manufacturer, or the manufacturer[s vendor, a claim for payment that is in
1861	1861	accordance with the national council for prescription drug programs[ standards for
1862	1862	electronic claims processing, except that no claim may be submitted if the
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1886	1886	ASSEMBLY BILL 62
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1888	1888	JPC:all
1889	1889	SECTION 21
1890	1890	manufacturer agrees to send the pharmacy a replacement of the same insulin in
1891	1891	the amount dispensed. If the pharmacy submits an electronic claim, the
1892	1892	manufacturer or vendor shall reimburse the pharmacy in an amount that covers
1893	1893	the pharmacy[s acquisition cost.
1894	1894	4. A pharmacy that dispenses insulin under subd. 2. shall retain a copy of the
1895	1895	application form described in subd. 1. a.
1896	1896	(d) Eligibility of certain individuals. An individual who has applied for public
1897	1897	assistance under ch. 49 but for whom a determination of eligibility has not been
1898	1898	made or whose coverage has not become effective or an individual who has an
1899	1899	appeal pending under sub. (3) (c) 4. may access insulin under this subsection if the
1900	1900	individual is in urgent need of insulin. To access a 30-day supply of insulin, the
1901	1901	individual shall attest to the pharmacy that the individual is described in this
1902	1902	paragraph and comply with par. (c) 1.
1903	1903	(3) PATIENT ASSISTANCE PROGRAM. (a) Establishment of program. No later
1904	1904	than July 1, 2026, each manufacturer shall establish a patient assistance program
1905	1905	to make insulin available in accordance with this subsection to individuals who
1906	1906	meet the eligibility requirements under par. (b). Under the patient assistance
1907	1907	program, the manufacturer shall do all of the following:
1908	1908	1. Provide the commissioner with information regarding the patient
1909	1909	assistance program, including contact information for individuals to call for
1910	1910	assistance in accessing the patient assistance program.
1911	1911	2. Provide a hotline for individuals to call or access between 8 a.m. and 10 p.m.
1912	1912	on weekdays and between 10 a.m. and 6 p.m. on Saturdays.
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1936	1936	ASSEMBLY BILL 62
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1938	1938	JPC:all
1939	1939	SECTION 21
1940	1940	3. List the eligibility requirements under par. (b) on the manufacturer[s
1941	1941	website.
1942	1942	4. Maintain the privacy of all information received from an individual
1943	1943	applying for or participating in the patient assistance program and not sell, share,
1944	1944	or disseminate the information unless required under this section or authorized, in
1945	1945	writing, by the individual.
1946	1946	(b) Eligible individual. An individual shall be eligible to receive insulin under
1947	1947	a patient assistance program if all of the following conditions are met:
1948	1948	1. The individual is a resident of this state.
1949	1949	2. The individual, or the individual[s parent or legal guardian if the individual
1950	1950	is under the age of 18, has a valid Wisconsin driver[s license or state identification
1951	1951	card.
1952	1952	3. The individual has a valid insulin prescription.
1953	1953	4. The family income of the individual does not exceed 400 percent of the
1954	1954	poverty line as defined and revised annually under 42 USC 9902 (2) for a family the
1955	1955	size of the individual[s family.
1956	1956	5. The individual is not receiving public assistance under ch. 49.
1957	1957	6. The individual is not eligible to receive health care through a federally
1958	1958	funded program or receive prescription drug benefits through the U.S. department
1959	1959	of veterans affairs, except that this subdivision does not apply to an individual who
1960	1960	is enrolled in a policy under Part D of Medicare under 42 USC 1395w-101 et seq. if
1961	1961	the individual has spent at least $1,000 on prescription drugs in the current
1962	1962	calendar year.
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1986	1986	ASSEMBLY BILL 62
1987	1987	- 42 - LRB-1302/1
1988	1988	JPC:all
1989	1989	SECTION 21
1990	1990	7. The individual is not enrolled in prescription drug coverage through an
1991	1991	individual or group health plan that limits the total cost sharing amount, including
1992	1992	copayments, deductibles, and coinsurance, that an enrollee is required to pay for a
1993	1993	30-day supply of insulin to no more than $75, regardless of the type or amount of
1994	1994	insulin needed.
1995	1995	(c) Application for patient assistance program. 1. An individual may apply to
1996	1996	participate in a patient assistance program by filing an application with the
1997	1997	manufacturer that established the patient assistance program, the individual[s
1998	1998	health care practitioner if the practitioner participates in the patient assistance
1999	1999	program, or a navigator included on the list under sub. (8) (c). A health care
2000	2000	practitioner or navigator shall immediately submit the application to the
2001	2001	manufacturer. Upon receipt of an application, the manufacturer shall determine
2002	2002	the individual[s eligibility under par. (b) and, except as provided in subd. 2., notify
2003	2003	the individual of the determination no later than 10 days after receipt of the
2004	2004	application.
2005	2005	2. If necessary to determine the individual[s eligibility under par. (b), the
2006	2006	manufacturer may request additional information from an individual who has filed
2007	2007	an application under subd. 1. no later than 5 days after receipt of the application.
2008	2008	Upon receipt of the additional information, the manufacturer shall determine the
2009	2009	individual[s eligibility under par. (b) and notify the individual of the determination
2010	2010	no later than 3 days after receipt of the requested information.
2011	2011	3. Except as provided in subd. 5., if the manufacturer determines under subd.
2012	2012	1. or 2. that the individual is eligible for the patient assistance program, the
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2036	2036	ASSEMBLY BILL 62
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2038	2038	JPC:all
2039	2039	SECTION 21
2040	2040	manufacturer shall provide the individual with a statement of eligibility. The
2041	2041	statement of eligibility shall be valid for 12 months and may be renewed upon a
2042	2042	determination by the manufacturer that the individual continues to meet the
2043	2043	eligibility requirements under par. (b).
2044	2044	4. If the manufacturer determines under subd. 1. or 2. that the individual is
2045	2045	not eligible for the patient assistance program, the manufacturer shall provide the
2046	2046	reason for the determination in the notification under subd. 1. or 2. The individual
2047	2047	may appeal the determination by filing an appeal with the commissioner that shall
2048	2048	include all of the information provided to the manufacturer under subds. 1. and 2.
2049	2049	The commissioner shall establish procedures for deciding appeals under this
2050	2050	subdivision. The commissioner shall issue a decision no later than 10 days after the
2051	2051	appeal is filed, and the commissioner[s decision shall be final. If the commissioner
2052	2052	determines that the individual meets the eligibility requirements under par. (b), the
2053	2053	manufacturer shall provide the individual with the statement of eligibility
2054	2054	described in subd. 3.
2055	2055	5. In the case of an individual who has prescription drug coverage through an
2056	2056	individual or group health plan, if the manufacturer determines under subd. 1. or 2.
2057	2057	that the individual is eligible for the patient assistance program but also
2058	2058	determines that the individual[s insulin needs are better addressed through the use
2059	2059	of the manufacturer[s copayment assistance program rather than the patient
2060	2060	assistance program, the manufacturer shall inform the individual of the
2061	2061	determination and provide the individual with the necessary coupons to submit to
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2084	2084	ASSEMBLY BILL 62
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2086	2086	JPC:all
2087	2087	SECTION 21
2088	2088	a pharmacy. The individual may not be required to pay more than the copayment
2089	2089	amount specified in par. (d) 2.
2090	2090	(d) Provision of insulin under a patient assistance program. 1. Upon receipt
2091	2091	from an individual of the eligibility statement described in par. (c) 3. and a valid
2092	2092	insulin prescription, a pharmacy shall submit an order containing the name of the
2093	2093	insulin and daily dosage amount to the manufacturer. The pharmacy shall include
2094	2094	with the order the pharmacy[s name, shipping address, office telephone number,
2095	2095	fax number, email address, and contact name, as well as any days or times when
2096	2096	deliveries are not accepted by the pharmacy.
2097	2097	2. Upon receipt of an order meeting the requirements under subd. 1., the
2098	2098	manufacturer shall send the pharmacy a 90-day supply of insulin, or lesser amount
2099	2099	if requested in the order, at no charge to the individual or pharmacy. The pharmacy
2100	2100	shall dispense the insulin to the individual associated with the order. The insulin
2101	2101	shall be dispensed at no charge to the individual, except that the pharmacy may
2102	2102	collect a copayment from the individual to cover the pharmacy[s costs for processing
2103	2103	and dispensing in an amount not to exceed $50 for each 90-day supply of insulin.
2104	2104	The pharmacy may not seek reimbursement from the manufacturer or a 3rd-party
2105	2105	payer.
2106	2106	3. The pharmacy may submit a reorder to the manufacturer if the individual[s
2107	2107	eligibility statement described in par. (c) 3. has not expired. The reorder shall be
2108	2108	treated as an order for purposes of subd. 2.
2109	2109	4. Notwithstanding subds. 2. and 3., a manufacturer may send the insulin
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2131	2131	22 2025 - 2026 Legislature
2132	2132	ASSEMBLY BILL 62
2133	2133	- 45 - LRB-1302/1
2134	2134	JPC:all
2135	2135	SECTION 21
2136	2136	directly to the individual if the manufacturer provides a mail-order service option,
2137	2137	in which case the pharmacy may not collect a copayment from the individual.
2138	2138	(4) EXCEPTIONS. (a) This section does not apply to a manufacturer that shows
2139	2139	to the commissioner[s satisfaction that the manufacturer[s annual gross revenue
2140	2140	from insulin sales in this state does not exceed $2,000,000.
2141	2141	(b) A manufacturer may not be required to make an insulin product available
2142	2142	under sub. (2) or (3) if the wholesale acquisition cost of the insulin product does not
2143	2143	exceed $8, as adjusted annually based on the U.S. consumer price index for all
2144	2144	urban consumers, U.S. city average, per milliliter or the applicable national council
2145	2145	for prescription drug programs[ plan billing unit.
2146	2146	(5) CONFIDENTIALITY. All medical information solicited or obtained by any
2147	2147	person under this section shall be subject to the applicable provisions of state law
2148	2148	relating to confidentiality of medical information, including s. 610.70.
2149	2149	(6) REIMBURSEMENT PROHIBITION. No person, including a manufacturer,
2150	2150	pharmacy, pharmacist, or 3rd-party administrator, as part of participating in an
2151	2151	urgent need safety net program or patient assistance program may request or seek,
2152	2152	or cause another person to request or seek, any reimbursement or other
2153	2153	compensation for which payment may be made in whole or in part under a federal
2154	2154	health care program, as defined in 42 USC 1320a-7b (f).
2155	2155	(7) REPORTS. (a) Annually, no later than March 1, each manufacturer shall
2156	2156	report to the commissioner all of the following information for the previous calendar
2157	2157	year:
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2180	2180	ASSEMBLY BILL 62
2181	2181	- 46 - LRB-1302/1
2182	2182	JPC:all
2183	2183	SECTION 21
2184	2184	1. The number of individuals who received insulin under the manufacturer[s
2185	2185	urgent need safety net program.
2186	2186	2. The number of individuals who sought assistance under the
2187	2187	manufacturer[s patient assistance program and the number of individuals who
2188	2188	were determined to be ineligible under sub. (3) (c) 4.
2189	2189	3. The wholesale acquisition cost of the insulin provided by the manufacturer
2190	2190	through the urgent need safety net program and patient assistance program.
2191	2191	(b) Annually, no later than April 1, the commissioner shall submit to the
2192	2192	governor and the chief clerk of each house of the legislature, for distribution to the
2193	2193	legislature under s. 13.172 (2), a report on the urgent need safety net programs and
2194	2194	patient assistance programs that includes all of the following:
2195	2195	1. The information provided to the commissioner under par. (a).
2196	2196	2. The forfeitures assessed under sub. (9) during the previous calendar year,
2197	2197	including the name of the manufacturer and amount of the forfeiture.
2198	2198	(8) ADDITIONAL RESPONSIBILITIES OF COMMISSIONER. (a) Application form.
2199	2199	The commissioner shall make the application form described in sub. (2) (c) 1. a.
2200	2200	available on the office[s website and shall make the form available to pharmacies
2201	2201	and health care providers who prescribe or dispense insulin, hospital emergency
2202	2202	departments, urgent care clinics, and community health clinics.
2203	2203	(b) Public outreach. 1. The commissioner shall conduct public outreach to
2204	2204	create awareness of the urgent need safety net programs and patient assistance
2205	2205	programs.
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2227	2227	22 2025 - 2026 Legislature
2228	2228	ASSEMBLY BILL 62
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2230	2230	JPC:all
2231	2231	SECTION 21
2232	2232	2. The commissioner shall develop and make available on the office[s website
2233	2233	an information sheet that contains all of the following information:
2234	2234	a. A description of how to access insulin through an urgent need safety net
2235	2235	program.
2236	2236	b. A description of how to access insulin through a patient assistance
2237	2237	program.
2238	2238	c. Information on how to contact a navigator for assistance in accessing
2239	2239	insulin through an urgent need safety net program or patient assistance program.
2240	2240	d. Information on how to contact the commissioner if a manufacturer
2241	2241	determines that an individual is not eligible for a patient assistance program.
2242	2242	e. A notification that an individual may contact the commissioner for more
2243	2243	information or assistance in accessing ongoing affordable insulin options.
2244	2244	(c) Navigators. The commissioner shall develop a training program to provide
2245	2245	navigators with information and the resources necessary to assist individuals in
2246	2246	accessing appropriate long-term insulin options. The commissioner shall compile a
2247	2247	list of navigators that have completed the training program and are available to
2248	2248	assist individuals in accessing affordable insulin coverage options. The list shall be
2249	2249	made available on the office[s website and to pharmacies and health care
2250	2250	practitioners who dispense and prescribe insulin.
2251	2251	(d) Satisfaction surveys. 1. The commissioner shall develop and conduct a
2252	2252	satisfaction survey of individuals who have accessed insulin through urgent need
2253	2253	safety net programs and patient assistance programs. The survey shall ask
2254	2254	whether the individual is still in need of a long-term solution for affordable insulin
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2277	2277	23 2025 - 2026 Legislature
2278	2278	ASSEMBLY BILL 62
2279	2279	- 48 - LRB-1302/1
2280	2280	JPC:all
2281	2281	SECTION 21
2282	2282	and shall include questions about the individual[s satisfaction with all of the
2283	2283	following, if applicable:
2284	2284	a. Accessibility to urgent-need insulin.
2285	2285	b. Adequacy of the information sheet and list of navigators received from the
2286	2286	pharmacy.
2287	2287	c. Helpfulness of a navigator.
2288	2288	d. Ease of access in applying for a patient assistance program and receiving
2289	2289	insulin from the pharmacy under the patient assistance program.
2290	2290	2. The commissioner shall develop and conduct a satisfaction survey of
2291	2291	pharmacies that have dispensed insulin through urgent need safety net programs
2292	2292	and patient assistance programs. The survey shall include questions about the
2293	2293	pharmacy[s satisfaction with all of the following, if applicable:
2294	2294	a. Timeliness of reimbursement from manufacturers for insulin dispensed by
2295	2295	the pharmacy under urgent need safety net programs.
2296	2296	b. Ease in submitting insulin orders to manufacturers.
2297	2297	c. Timeliness of receiving insulin orders from manufacturers.
2298	2298	3. The commissioner may contract with a nonprofit entity to develop and
2299	2299	conduct the surveys under subds. 1. and 2. and to evaluate the survey results.
2300	2300	4. No later than July 1, 2028, the commissioner shall submit to the governor
2301	2301	and the chief clerk of each house of the legislature, for distribution to the legislature
2302	2302	under s. 13.172 (2), a report on the results of the surveys under subds. 1. and 2.
2303	2303	(9) PENALTY. A manufacturer that fails to comply with this section may be
2304	2304	required to forfeit up to $200,000 per month of noncompliance, with the maximum
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2327	2327	23 2025 - 2026 Legislature
2328	2328	ASSEMBLY BILL 62
2329	2329	- 49 - LRB-1302/1
2330	2330	JPC:all
2331	2331	SECTION 21
2332	2332	forfeiture increasing to $400,000 per month if the manufacturer continues to be in
2333	2333	noncompliance after 6 months and increasing to $600,000 per month if the
2334	2334	manufacturer continues to be in noncompliance after one year.
2335	2335	SECTION 22. 632.869 of the statutes is created to read:
2336	2336	632.869 Reimbursement to federal drug pricing program
2337	2337	participants. (1) In this section:
2338	2338	(a) XCovered entityY means an entity described in 42 USC 256b (a) (4) (A), (D),
2339	2339	(E), (J), or (N) that participates in the federal drug pricing program under 42 USC
2340	2340	256b, a pharmacy of the entity, or a pharmacy contracted with the entity to
2341	2341	dispense drugs purchased through the federal drug pricing program under 42 USC
2342	2342	256b.
2343	2343	(b) XPharmacy benefit managerY has the meaning given in s. 632.865 (1) (c).
2344	2344	(2) No person, including a pharmacy benefit manager or 3rd-party payer, may
2345	2345	do any of the following:
2346	2346	(a) Reimburse a covered entity for a drug that is subject to an agreement
2347	2347	under 42 USC 256b at a rate lower than that paid for the same drug to pharmacies
2348	2348	that are not covered entities and have a similar prescription volume to that of the
2349	2349	covered entity.
2350	2350	(b) Assess a covered entity any fee, charge back, or other adjustment on the
2351	2351	basis of the covered entity[s participation in the federal drug pricing program under
2352	2352	42 USC 256b.
2353	2353	SECTION 23. 632.895 (6) (title) of the statutes is amended to read:
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2375	2375	22 2025 - 2026 Legislature
2376	2376	ASSEMBLY BILL 62
2377	2377	- 50 - LRB-1302/1
2378	2378	JPC:all
2379	2379	SECTION 23
2380	2380	632.895 (6) (title) EQUIPMENT AND SUPPLIES FOR TREATMENT OF DIABETES;
2381	2381	INSULIN.
2382	2382	SECTION 24. 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and
2383	2383	amended to read:
2384	2384	632.895 (6) (a) Every disability insurance policy which that provides coverage
2385	2385	of expenses incurred for treatment of diabetes shall provide coverage for expenses
2386	2386	incurred by the installation and use of an insulin infusion pump, coverage for all
2387	2387	other equipment and supplies, including insulin or any other prescription
2388	2388	medication, used in the treatment of diabetes, and coverage of diabetic self-
2389	2389	management education programs. Coverage Except as provided in par. (b),
2390	2390	coverage required under this subsection shall be subject to the same exclusions,
2391	2391	limitations, deductibles, and coinsurance provisions of the policy as other covered
2392	2392	expenses, except that insulin infusion pump coverage may be limited to the
2393	2393	purchase of one pump per year and the insurer may require the insured to use a
2394	2394	pump for 30 days before purchase.
2395	2395	SECTION 25. 632.895 (6) (b) of the statutes is created to read:
2396	2396	632.895 (6) (b) 1. In this paragraph:
2397	2397	a. XCost sharingY means the total of any deductible, copayment, or
2398	2398	coinsurance amounts imposed on a person covered under a policy or plan.
2399	2399	b. XSelf-insured health planY has the meaning given in s. 632.85 (1) (c).
2400	2400	2. Every disability insurance policy and self-insured health plan that covers
2401	2401	insulin and imposes cost sharing on prescription drugs may not impose cost sharing
2402	2402	on insulin in an amount that exceeds $35 for a one-month supply of insulin.
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2425	2425	23 2025 - 2026 Legislature
2426	2426	ASSEMBLY BILL 62
2427	2427	- 51 - LRB-1302/1
2428	2428	JPC:all
2429	2429	SECTION 25
2430	2430	3. Nothing in this paragraph prohibits a disability insurance policy or self-
2431	2431	insured health plan from imposing cost sharing on insulin in an amount less than
2432	2432	the amount specified under subd. 2. Nothing in this paragraph requires a disability
2433	2433	insurance policy or self-insured health plan to impose any cost sharing on insulin.
2434	2434	SECTION 26. Nonstatutory provisions.
2435	2435	(1) CENTRALIZED DRUG REPOSITORY. The department of health services shall
2436	2436	study and implement a centralized, physical drug repository program under s.
2437	2437	255.056.
2438	2438	(2) PRESCRIPTION DRUG IMPORTATION PROGRAM. The commissioner of
2439	2439	insurance shall submit the first report required under s. 601.575 (5) by the next
2440	2440	January 1 or July 1, whichever is earliest, that is at least 180 days after the date the
2441	2441	prescription drug importation program is fully operational under s. 601.575 (4).
2442	2442	The commissioner of insurance shall include in the first 3 reports submitted under
2443	2443	s. 601.575 (5) information on the implementation of the audit functions under s.
2444	2444	601.575 (1) (n).
2445	2445	(3) PRESCRIPTION DRUG PURCHASING ENTITY. During the 2025-27 fiscal
2446	2446	biennium, the office of the commissioner of insurance shall conduct a study on the
2447	2447	viability of creating or implementing a state prescription drug purchasing entity.
2448	2448	(4) OFFICE OF PRESCRIPTION DRUG AFFORDABILITY. The office of the
2449	2449	commissioner of insurance shall establish an office of prescription drug
2450	2450	affordability in the office of the commissioner of insurance. The office of
2451	2451	prescription drug affordability shall be responsible for prescription drug
2452	2452	affordability programming within the office of the commissioner of insurance and
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2476	2476	ASSEMBLY BILL 62
2477	2477	- 52 - LRB-1302/1
2478	2478	JPC:all
2479	2479	SECTION 26
2480	2480	shall oversee the operations of the prescription drug affordability review board
2481	2481	established under s. 15.735.
2482	2482	(5) STAGGERED TERMS FOR PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD.
2483	2483	Notwithstanding the length of terms specified for the members of the board under
2484	2484	s. 15.735 (1) (b) to (e), 2 of the initial members shall be appointed for terms expiring
2485	2485	on May 1, 2026; 2 of the initial members shall be appointed for terms expiring on
2486	2486	May 1, 2027; 2 of the initial members shall be appointed for terms expiring on May
2487	2487	1, 2028; and 2 of the initial members shall be appointed for terms expiring on May
2488	2488	1, 2029.
2489	2489	SECTION 27. Fiscal changes.
2490	2490	(1) OFFICE OF PRESCRIPTION DRUG AFFORDABILITY. In the schedule under s.
2491	2491	20.005 (3) for the appropriation to the office of the commissioner of insurance under
2492	2492	s. 20.145 (1) (g), the dollar amount for fiscal year 2026-27 is increased by $1,701,000
2493	2493	to provide $500,000 in onetime implementation costs for establishing an office of
2494	2494	prescription drug affordability in the office of the commissioner of insurance and
2495	2495	$1,201,000 to increase the authorized FTE positions for the office of the
2496	2496	commissioner of insurance by 16.0 PR positions within the office of prescription
2497	2497	drug affordability, including 5.0 insurance examiners, 4.0 policy initiatives
2498	2498	advisors, 2.0 attorneys, 1.0 insurance program manager, 2.0 insurance
2499	2499	administrators, and 2.0 operations program associates.
2500	2500	SECTION 28. Effective dates. This act takes effect on the day after
2501	2501	publication, except as follows:
2502	2502	(1) COST-SHARING CAP ON INSULIN. The treatment of ss. 609.83 and 632.895
2503	2503	(6) (title), the renumbering and amendment of s. 632.895 (6), and the creation of s.
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2527	2527	24 2025 - 2026 Legislature
2528	2528	ASSEMBLY BILL 62
2529	2529	- 53 - LRB-1302/1
2530	2530	JPC:all
2531	2531	SECTION 28
2532	2532	632.895 (6) (b) take effect on the first day of the 4th month beginning after
2533	2533	publication.
2534	2534	(2) PHARMACY BENEFIT TOOL GRANTS. The treatment of ss. 20.005 (3)
2535	2535	(schedule), 20.145 (1) (a), and 601.415 (14) takes effect on the day after publication,
2536	2536	or on the 2nd day after publication of the 2025 biennial budget act, whichever is
2537	2537	later.
2538	2538	(3) LICENSURE OF PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS AND
2539	2539	PHARMACEUTICAL REPRESENTATIVES . The treatment of ss. 601.31 (1) (nv) and (nw),
2540	2540	601.56, and 601.57 takes effect on the first day of the 7th month beginning after
2541	2541	publication.
2542	2542	(4) PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD. The treatment of ss.
2543	2543	15.07 (3) (bm) 7., 15.735, and 20.145 (1) (g) 4. and subch. VI of ch. 601 and SECTIONS
2544	2544	26 (4) and (5) and 27 (1) of this act take effect on the first day of the 7th month
2545	2545	beginning after publication or on the 2nd day after publication of the 2025 biennial
2546	2546	budget act, whichever is later.
2547	2547	(END)
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