Wisconsin Assembly Bill AB62 Latest Draft

                            2025 - 2026  LEGISLATURE
LRB-1302/1
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2025 ASSEMBLY BILL 62
February 24, 2025 - Introduced by Representatives SUBECK, SPAUDE, JOHNSON, 
ANDERSON, ANDRACA, ARNEY, BARE, BILLINGS, BROWN, CRUZ, DESANTO, 
DESMIDT, DOYLE, EMERSON, FITZGERALD, GOODWIN, HAYWOOD, HONG, 
HYSELL, J. JACOBSON, JOERS, KIRSCH, MADISON, MAYADEV, MCCARVILLE, 
MCGUIRE, MIRESSE, MOORE OMOKUNDE, NEUBAUER, ORTIZ-VELEZ, PALMERI, 
PHELPS, PRADO, RIVERA-WAGNER, ROE, SHEEHAN, SINICKI, SNODGRASS, 
STROUD, STUBBS, TAYLOR, TENORIO, UDELL and VINING, cosponsored by 
Senators PFAFF, HESSELBEIN, DRAKE, CARPENTER, DASSLER-ALFHEIM, 
HABUSH SINYKIN, L. JOHNSON, KEYESKI, RATCLIFF, ROYS, SMITH, SPREITZER, 
WALL and WIRCH. Referred to Committee on Health, Aging and Long-Term 
Care. 
 
 ***AUTHORS SUBJECT TO CHANGE***
AN ACT to repeal 49.45 (18) (ag); to renumber and amend 632.895 (6); to 
amend 49.45 (18) (ac), 609.83 and 632.895 (6) (title); to create 15.07 (3) (bm) 
7., 15.735, 20.145 (1) (a), 20.145 (1) (g) 4., 49.45 (18) (b) 8., 255.056 (2g), 
450.085 (3), 601.31 (1) (nv), 601.31 (1) (nw), 601.41 (14), 601.415 (14), 601.56, 
601.57, 601.575, subchapter VI of chapter 601 [precedes 601.78], 632.865 
(2m), 632.868, 632.869 and 632.895 (6) (b) of the statutes; relating to: health 
care costs omnibus, granting rule-making authority, making an 
appropriation, and providing a penalty.
Analysis by the Legislative Reference Bureau
Elimination of cost sharing for prescription drugs under the Medical 
Assistance program
Under current law, certain persons who receive health services under the 
Medical Assistance program, also known in this state as BadgerCare, are required 
to contribute a cost-sharing payment to the cost of certain health services.  This bill 
eliminates all cost-sharing payments for prescription drugs under the Medical 
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Assistance program.  The Medical Assistance program is a joint state and federal 
program that provides health services to individuals who have limited financial 
resources.
Cost-sharing cap on insulin
The bill prohibits every health insurance policy and governmental self-insured 
health plan that covers insulin and imposes cost sharing on prescription drugs from 
imposing cost sharing on insulin in an amount that exceeds $35 for a one-month 
supply.  Current law requires every health insurance policy that provides coverage 
of expenses incurred for treatment of diabetes to provide coverage for specified 
expenses and items, including insulin.  The required coverage under current law for 
certain diabetes treatments other than insulin infusion pumps is subject to the 
same exclusions, limitations, deductibles, and coinsurance provisions of the policy 
as other covered expenses.  The bill[s cost-sharing limitation on insulin supersedes 
the specification that the exclusions, limitations, deductibles, and coinsurance are 
the same as for other coverage.
Fiduciary and disclosure requirements for pharmacy benefit managers
The bill imposes fiduciary and disclosure requirements on pharmacy benefit 
managers.  Pharmacy benefit managers contract with health plans that provide 
prescription drug benefits to administer those benefits for the plans.  They also 
have contracts with pharmacies and pay the pharmacies for providing drugs to the 
plan beneficiaries.
The bill provides that a pharmacy benefit manager owes a fiduciary duty to a 
health plan sponsor. The bill also requires that a pharmacy benefit manager 
annually disclose all of the following information to the plan sponsor:
1.  The indirect profit received by the pharmacy benefit manager from owning 
a pharmacy or service provider.
2.  Any payments made to a consultant or broker who works on behalf of the 
plan sponsor.
3. From the amounts received from drug manufacturers, the amounts 
retained by the pharmacy benefit manager that are related to the plan sponsor[s 
claims or bona fide service fees.
4.  The amounts received from network pharmacies and the amount retained 
by the pharmacy benefit manager.
Reimbursements for certain 340B program entities
The bill prohibits any person from reimbursing certain entities that 
participate in the federal drug pricing program, known as the 340B program, for a 
drug subject to an agreement under the program at a rate lower than that paid for 
the same drug to pharmacies that have a similar prescription volume.  The bill also 
prohibits a person from imposing any fee, charge back, or other adjustment on the 
basis of the entity[s participation in the 340B program.  The entities covered by the 
prohibitions under the bill are federally qualified health centers, critical access 
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as these entities[ pharmacies and any pharmacy with which any of the entities have 
contracted to dispense drugs through the 340B program.
Drug repository program
Under current law, the Department of Health Services must maintain a drug 
repository program under which any person may donate certain drugs or supplies 
to be dispensed to and used by eligible individuals, prioritizing uninsured and 
indigent individuals. The bill allows DHS to partner with out-of-state drug 
repository programs.  The bill also allows out-of-state persons to donate to the drug 
repository program in Wisconsin and persons in Wisconsin to donate to 
participating drug repository programs in other states.  Further, the bill directs 
DHS to study and implement a centralized, physical drug repository program.
Value-based diabetes medication pilot project
The bill directs the Office of the Commissioner of Insurance to develop a pilot 
project under which a pharmacy benefit manager and pharmaceutical 
manufacturer are directed to create a value-based, sole-source arrangement to 
reduce the costs of prescription diabetes medication. The bill allows OCI to 
promulgate rules to implement the pilot project.
Pharmacist continuing education credits for volunteering at free and 
charitable clinics
Under current law, a licensed pharmacist must renew his or her license every 
two years.  An applicant for renewal of a pharmacist license must submit proof that 
he or she has completed 30 hours of continuing education within the two-year 
period immediately preceding the date of his or her application.  The bill allows 
pharmacists to meet up to 10 hours of the continuing education requirement for 
each two-year period by volunteering at a free and charitable clinic approved by the 
Pharmacy Examining Board.
Prescription drug importation program
The bill requires the commissioner of insurance, in consultation with persons 
interested in the sale and pricing of prescription drugs and federal officials and 
agencies, to design and implement a prescription drug importation program for the 
benefit of and that generates savings for Wisconsin residents.  The bill establishes 
requirements for the program, including all of the following:
1. The commissioner must designate a state agency to become a licensed 
wholesale distributor or contract with a licensed wholesale distributor and to seek 
federal certification and approval to import prescription drugs.
2.  The program must comply with certain federal regulations and import from 
Canadian suppliers only prescription drugs that are not brand-name drugs, have 
fewer than four competitor drugs in this country, and for which importation creates 
substantial savings.
3.  The commissioner must ensure that prescription drugs imported under the 
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4.  The program must have an audit procedure to ensure the program complies 
with certain requirements specified in the bill.
Before submitting the proposed program to the federal government for 
certification, the commissioner must submit the proposed program to the Joint 
Committee on Finance for its approval.
Pharmacy benefits tool grants
The bill directs OCI to award grants in an amount of up to $500,000 in each 
fiscal year to health care providers to develop and implement a patient pharmacy 
benefits tool that would allow prescribers to disclose the cost of prescription drugs 
for patients. The tool must be usable by physicians and other prescribers to 
determine the cost of prescription drugs for their patients. Any health care 
provider that receives a grant to develop and implement a patient pharmacy 
benefits tool is required to contribute matching funds equal to at least 50 percent of 
the total grant awarded.
Prescription drug purchasing entity study
The bill requires OCI to conduct a study on the viability of creating or 
implementing a state prescription drug purchasing entity.
Licensure of pharmacy services administrative organizations
The bill requires that a pharmacy services administrative organization 
(PSAO) be licensed by OCI. Under the bill, a PSAO is an entity operating in 
Wisconsin that does all of the following:
1. Contracts with an independent pharmacy to conduct business on the 
pharmacy[s behalf with a third-party payer.
2.  Provides at least one administrative service to an independent pharmacy 
and negotiates and enters into a contract with a third-party payer or pharmacy 
benefit manager on the pharmacy[s behalf.
The bill defines Xindependent pharmacyY to mean a licensed pharmacy 
operating in Wisconsin that is under common ownership with no more than two 
other pharmacies.  XAdministrative serviceY is defined to mean assisting with 
claims or audits, providing centralized payment, performing certification in a 
specialized care program, providing compliance support, setting flat fees for generic 
drugs, assisting with store layout, managing inventory, providing marketing 
support, providing management and analysis of payment and drug dispensing data, 
or providing resources for retail cash cards.  The bill defines Xthird-party payerY to 
mean an entity operating in Wisconsin that pays or insures health, medical, or 
prescription drug expenses on behalf of beneficiaries.  The bill uses the current law 
definition of Xpharmacy benefit manager,Y which is an entity doing business in 
Wisconsin that contracts to administer or manage prescription drug benefits on 
behalf of an insurer or other entity that provides prescription drug benefits to 
Wisconsin residents.
To obtain the license required by the bill, a person must apply to OCI and 
provide the contact information for the applicant and a contact person, evidence of  2025 - 2026  Legislature
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financial responsibility of at least $1,000,000, and any other information required 
by the commissioner by rule. Under the bill, the license fee is set by the 
commissioner, and the term of a license is two years.
The bill also requires that a PSAO disclose to OCI the extent of any ownership 
or control by an entity that provides pharmacy services; provides prescription drug 
or device services; or manufactures, sells, or distributes prescription drugs, 
biologicals, or medical devices.  The PSAO must notify OCI within five days of any 
material change in its ownership or control related to such an entity.
Licensure of pharmaceutical representatives
The bill requires a pharmaceutical representative to be licensed by OCI and to 
display the pharmaceutical representative[s license during each visit with a health 
care professional. The bill defines Xpharmaceutical representativeY to mean an 
individual who markets or promotes pharmaceuticals to health care professionals 
on behalf of a pharmaceutical manufacturer for compensation.
The term of a license issued under the bill is one year, and the license is 
renewable. The application to obtain or renew a license must include the 
applicant[s contact information, a description of the type of work in which the 
applicant will engage, the license fee, an attestation that professional education 
requirements are met, proof that any penalties and other fees are paid, and any 
other information required by OCI by rule.  Under the bill, the license fee is set by 
the commissioner.  The bill requires the pharmaceutical representative to report, 
within four business days, any change to the information provided on the 
application or any material change to the pharmaceutical representative[s business 
operations or other information required to be reported under the bill.
The bill requires that a pharmaceutical representative complete a professional 
education course prior to becoming licensed and to annually complete at least five 
hours of continuing professional education courses.  The coursework must include, 
at a minimum, training in ethical standards, whistleblower protections, and the 
laws and rules applicable to pharmaceutical marketing. The bill directs the 
commissioner to regularly publish a list of courses that fulfill the education 
requirements. Under the bill, a course provider must disclose any conflict of 
interest to the commissioner, and the courses may not be provided by the employer 
of a pharmaceutical representative or be funded by the pharmaceutical industry or 
a third party funded by the industry.
The bill requires that, no later than June 1 of each year, a pharmaceutical 
representative report to OCI the pharmaceutical representative[s total number of 
contacts with health care professionals in Wisconsin, the specialties of those health 
care professionals, the location and duration of each contact, the pharmaceuticals 
discussed, and the value of any item provided to a health care professional.  The bill 
directs the commissioner to publish the information on OCI[s website without 
identifying individual health care professionals.
The bill requires that a pharmaceutical representative, during each contact 
with a health care professional, disclose the wholesale acquisition cost of any  2025 - 2026  Legislature
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pharmaceuticals discussed and the names of at least three generic prescription 
drugs from the same therapeutic class.
The bill directs the commissioner to promulgate ethical standards for 
pharmaceutical representatives.  Additionally, the bill prohibits a pharmaceutical 
representative from engaging in deceptive or misleading marketing of a 
pharmaceutical product; using a title or designation that could reasonably lead a 
licensed health care professional, or an employee or representative of such a 
professional, to believe that the pharmaceutical representative is licensed to 
practice in a health occupation unless the pharmaceutical representative holds a 
license to practice in that health occupation; or attending a patient examination 
without the patient[s consent.
An individual who violates any of the requirements under the bill is subject to 
a forfeiture, and the individual[s license may be suspended or revoked. An 
individual whose license is revoked must wait at least two years before applying for 
a new license.
Insulin safety net programs
The bill requires insulin manufacturers to establish a program under which 
qualifying Wisconsin residents who are in urgent need of insulin and are uninsured 
or have limited insurance coverage can be dispensed insulin at a pharmacy.  An 
individual is in urgent need of insulin if the individual needs insulin in order to 
avoid the likelihood of suffering a significant health consequence and possesses less 
than a seven-day supply of insulin readily available for use.  Under the program, if 
a qualifying individual in urgent need of insulin provides a pharmacy with a form 
attesting that the individual meets the program[s eligibility requirements, specified 
proof of residency, and a valid insulin prescription, the pharmacy must dispense a 
30-day supply of insulin to the individual and may charge the individual a 
copayment of no more than $35.  The pharmacy may submit an electronic payment 
claim for the insulin[s acquisition cost to the manufacturer or agree to receive a 
replacement of the same insulin in the amount dispensed.
The bill also requires that each insulin manufacturer establish a patient 
assistance program to make insulin available to any qualifying Wisconsin resident 
who, among other requirements, is uninsured or has limited insurance coverage 
and whose family income does not exceed 400 percent of the federal poverty line.  
Under the bill, an individual must apply to participate in a manufacturer[s 
program.  If the manufacturer determines that the individual meets the program[s 
eligibility requirements, the manufacturer must issue the individual a statement of 
eligibility, which is valid for 12 months and may be renewed.  Under the bill, if an 
individual with a statement of eligibility and valid insulin prescription requests 
insulin from a pharmacy, the pharmacy must submit an order to the manufacturer, 
who must then provide a 90-day supply of insulin at no charge to the individual or 
pharmacy.  The pharmacy may charge the individual a copayment of no more than 
$50. Under the bill, a manufacturer is not required to issue a statement of 
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group health plan and the manufacturer determines that the individual[s insulin 
needs are better addressed through the manufacturer[s copayment assistance 
program. In such case, the manufacturer must provide the individual with 
necessary drug coupons to submit to a pharmacy, and the individual may not be 
required to pay more than a $50 copayment for a 90-day supply of insulin.
Under the bill, if the manufacturer determines that an individual is not 
eligible for the patient assistance program, the individual may file an appeal with 
OCI.  The bill directs OCI to establish procedures for deciding appeals.  Under the 
bill, OCI must issue a decision within 10 days, and that decision is final.
The bill requires that insulin manufacturers annually report to OCI certain 
information, including the number of individuals served and the cost of insulin 
dispensed under the programs and that OCI annually report to the governor and 
the legislature on the programs. The bill also directs OCI to conduct public 
outreach and develop an information sheet about the programs, conduct 
satisfaction surveys of individuals and pharmacies that participate in the 
programs, and report to the governor and the legislature on the surveys by July 1, 
2028.  Additionally, the bill requires that OCI develop a training program for health 
care navigators to assist individuals in accessing appropriate long-term insulin 
options and maintain a list of trained navigators.
The bill provides that a manufacturer that fails to comply with the bill[s 
provisions may be assessed a forfeiture of up to $200,000 per month of 
noncompliance, which increases to $400,000 per month if the manufacturer 
continues to be in noncompliance after six months and to $600,000 per month if the 
manufacturer continues to be in noncompliance after one year. The bill [s 
requirements do not apply to manufacturers with annual insulin sales revenue in 
Wisconsin of no more than $2,000,000 or to insulin that costs less than a specified 
dollar amount.
Prescription Drug Affordability Review Board
The bill creates a Prescription Drug Affordability Review Board, whose 
purpose is to protect Wisconsin residents and other stakeholders from the high 
costs of prescription drugs.  The board consists of the commissioner of insurance 
and the following members, all of whom are appointed by the governor for four-year 
terms:
1.  Two members who represent the pharmaceutical drug industry, at least 
one of whom is a licensed pharmacist.
2.  Two members who represent the health insurance industry.
3.  Two members who represent the health care industry, at least one of whom 
is a licensed practitioner.
4.  Two members who represent the interests of the public.
The bill requires the board to meet in open session at least four times per year 
to review prescription drug pricing information.  The board must provide at least 
two weeks[ public notice of each meeting, make the meeting[s materials publicly 
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public comment.  The bill imposes conflict of interest requirements for the board 
relating to recusal and public disclosure of certain conflicts.  The bill directs the 
board to access and assess drug pricing information, to the extent practicable, by 
accessing and assessing information from other states, by assessing spending for 
the drug in Wisconsin, and by accessing other available pricing information.
Under the bill, the board must conduct drug cost affordability reviews.  The 
board must identify prescription drugs whose launch wholesale acquisition cost 
exceeds specified thresholds, prescription drugs whose increase in wholesale 
acquisition cost exceeds specified thresholds, and other prescription drugs that may 
create affordability challenges for the health care system in Wisconsin.  For each 
identified prescription drug, the board must determine whether to conduct an 
affordability review by seeking stakeholder input and considering the average 
patient cost share for the drug.  During an affordability review, the board must 
determine whether use of the prescription drug that is fully consistent with the 
labeling approved by the federal Food and Drug Administration or standard 
medical practice has led or will lead to an affordability challenge for the health care 
system in Wisconsin.  In making this determination, the bill requires the board to 
consider a variety of factors, which include the following:
1.  The drug[s wholesale acquisition cost.
2. The average monetary price concession, discount, or rebate the 
manufacturer provides, or is expected to provide, for the drug to health plans.
3. The total amount of price concessions, discounts, and rebates the 
manufacturer provides to each pharmacy benefit manager for the drug.
4.  The price at which therapeutic alternatives have been sold and the average 
monetary concession, discount, or rebate the manufacturer provides, or is expected 
to provide, to health plan payors and pharmacy benefit managers for therapeutic 
alternatives.
5.  The costs to health plans based on patient access consistent with federal 
labeled indications and recognized standard medical practice.
6. The impact on patient access resulting from the drug[s cost relative to 
insurance benefit design.
7. The current or expected dollar value of drug-specific patient access 
programs that are supported by the manufacturer.
8.  The relative financial impacts to health, medical, or social services costs 
that can be quantified and compared to baseline effects of existing therapeutic 
alternatives.
9.  The average patient copay or other cost sharing for the drug.
If the board determines that a prescription drug will lead to an affordability 
challenge, the bill directs the board to establish an upper payment limit for that 
drug that applies to all purchases and payor reimbursements of the drug dispensed 
or administered to individuals in Wisconsin.  In establishing the upper payment 
limit, the board must consider the cost of administering the drug, the cost of 
delivering it to consumers, and other relevant administrative costs.  For certain  2025 - 2026  Legislature
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SECTION 1
drugs, the board must solicit information from the manufacturer regarding the 
price increase and, if the board determines that the price increase is not a result of 
the need for increased manufacturing capacity or other effort to improve patient 
access during a public health emergency, the board must establish an upper 
payment limit equal to the drug[s cost prior to the price increase.
Further, this bill provides $500,000 in program revenue in fiscal year 2026]27 
for onetime implementation costs associated with establishing an Office of 
Prescription Drug Affordability in OCI. The bill provides that the Office of 
Prescription Drug Affordability is responsible for prescription drug affordability 
programming within OCI and for overseeing the operations of the Prescription 
Drug Affordability Review Board.  Additionally, the bill authorizes and funds for 
fiscal year 2026]27 16.0 positions for the Office of Prescription Drug Affordability.
Finally, the bill credits to the appropriation account for OCI[s general program 
operations all moneys received from the regulation of pharmacy benefit managers, 
pharmacy benefit management brokers, pharmacy benefit management 
consultants, pharmacy services administrative organizations, and pharmaceutical 
sales representatives.
This proposal may contain a health insurance mandate requiring a social and 
financial impact report under s. 601.423, stats.
For further information see the state fiscal estimate, which will be printed as 
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do 
enact as follows:
SECTION 1.  15.07 (3) (bm) 7. of the statutes is created to read:
15.07 (3) (bm) 7.  The prescription drug affordability review board shall meet 
at least 4 times each year.
SECTION 2.  15.735 of the statutes is created to read:
15.735  Same; attached board.  (1) There is created a prescription drug 
affordability review board attached to the office of the commissioner of insurance 
under s. 15.03.  The board shall consist of the following members:
(a)  The commissioner of insurance or his or her designee.
(b) Two members appointed for 4-year terms who represent the 
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pharmaceutical drug industry, including pharmaceutical drug manufacturers and 
wholesalers.  At least one of the members appointed under this paragraph shall be 
a pharmacist licensed in this state.
(c) Two members appointed for 4-year terms who represent the health 
insurance industry, including insurers and pharmacy benefit managers.
(d)  Two members appointed for 4-year terms who represent the health care 
industry, including hospitals, physicians, pharmacies, and pharmacists.  At least 
one of the members appointed under this paragraph shall be a licensed health care 
practitioner.
(e)  Two members appointed for 4-year terms who represent the interests of 
the public.
(2)  A member appointed under sub. (1), except for a member appointed under 
sub. (1) (b), may not be an employee of, a board member of, or a consultant to a drug 
manufacturer or trade association for drug manufacturers.
(3)  Any conflict of interest, including any financial or personal association, 
that has the potential to bias or has the appearance of biasing an individual[s 
decision in matters related to the board or the conduct of the board[s activities shall 
be considered and disclosed when appointing that individual to the board under 
sub. (1).
SECTION 3.  20.005 (3) (schedule) of the statutes:  at the appropriate place, 
insert the following amounts for the purposes indicated:
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SECTION 3
2025-26 2026-27
20.145 Insurance, office of the commissioner of
(1) SUPERVISION OF THE INSURANCE INDUSTRY
(a) State operations	GPR A -0- 500,000
SECTION 4.  20.145 (1) (a) of the statutes is created to read:
20.145 (1) (a)  State operations. The amounts in the schedule for general 
program operations.
SECTION 5. 20.145 (1) (g) 4. of the statutes is created to read:
20.145 (1) (g) 4.  All moneys received from the regulation of pharmacy benefit 
managers, pharmacy benefit management brokers, pharmacy benefit management 
consultants, pharmacy services administrative organizations, and pharmaceutical 
sales representatives.
SECTION 6.  49.45 (18) (ac) of the statutes is amended to read:
49.45 (18) (ac)  Except as provided in pars. (am) to (d), and subject to par. (ag), 
any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the 
benefits under s. 49.46 (2) (a) and (b) under s. 49.471, shall pay up to the maximum 
amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services 
provided under s. 49.46 (2). The service provider shall collect the specified or 
allowable copayment, coinsurance, or deductible, unless the service provider 
determines that the cost of collecting the copayment, coinsurance, or deductible 
exceeds the amount to be collected.  The department shall reduce payments to each 
provider by the amount of the specified or allowable copayment, coinsurance, or 
deductible.  No provider may deny care or services because the recipient is unable to 
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share costs, but an inability to share costs specified in this subsection does not 
relieve the recipient of liability for these costs.
SECTION 7.  49.45 (18) (ag) of the statutes is repealed.
SECTION 8.  49.45 (18) (b) 8. of the statutes is created to read:
49.45 (18) (b) 8.  Prescription drugs.
SECTION 9.  255.056 (2g) of the statutes is created to read:
255.056 (2g) The department may partner with out-of-state drug repository 
programs. The department may authorize a medical facility or pharmacy that 
elects to participate in the drug repository program to receive drugs or supplies 
from out of state, and the department may authorize an out-of-state entity that 
participates in a partner out-of-state drug repository program to receive drugs or 
supplies from Wisconsin.
SECTION 10.  450.085 (3) of the statutes is created to read:
450.085 (3) An applicant for renewal of a license under s. 450.08 (2) (a) may 
count, for purposes of the continuing education requirement under sub. (1), up to 10 
hours spent as a volunteer at a free and charitable clinic approved by the board.
SECTION 11.  601.31 (1) (nv) of the statutes is created to read:
601.31 (1) (nv) For issuing or renewing a license as a pharmaceutical 
representative under s. 601.56, an amount to be set by the commissioner by rule.
SECTION 12.  601.31 (1) (nw) of the statutes is created to read:
601.31 (1) (nw)  For issuing or renewing a license as a pharmacy services 
administrative organization under s. 601.57, an amount to be set by the 
commissioner by rule.
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SECTION 13
SECTION 13.  601.41 (14) of the statutes is created to read:
601.41 (14) VALUE-BASED DIABETES MEDICATION PILOT PROJECT. The 
commissioner shall develop a pilot project to direct a pharmacy benefit manager, as 
defined in s. 632.865 (1) (c), and a pharmaceutical manufacturer to create a value-
based, sole-source arrangement to reduce the costs of prescription medication used 
to treat diabetes. The commissioner may promulgate rules to implement this 
subsection.
SECTION 14.  601.415 (14) of the statutes is created to read:
601.415 (14) PATIENT PHARMACY BENEFITS TOOL.  (a)  From the appropriation 
under s. 20.145 (1) (a), beginning in the 2026-27 fiscal year, the office shall award 
grants in a total amount of up to $500,000 each fiscal year to health care providers 
to develop and implement a tool for prescribers to disclose the cost of prescription 
drugs for patients.  The tool must be usable by physicians and other prescribers to 
determine the cost of prescription drugs for their patients.
(b) Any health care provider that receives a grant under par. (a) shall 
contribute matching funds equal to at least 50 percent of the grant amount 
awarded.
SECTION 15.  601.56 of the statutes is created to read:
601.56  Pharmaceutical representatives. (1) DEFINITIONS. In this 
section:
(a)  XHealth care professionalY means a physician or other health care 
practitioner who is licensed to provide health care services or to prescribe 
pharmaceutical or biologic products.
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(b)  XPharmaceuticalY means a medication that may legally be dispensed only 
with a valid prescription from a health care professional.
(c)  XPharmaceutical representativeY means an individual who markets or 
promotes pharmaceuticals to health care professionals on behalf of a 
pharmaceutical manufacturer for compensation.
(d)  XWholesale acquisition costY means the most recently reported 
manufacturer list or catalog price for a brand-name or generic drug available to 
wholesalers or direct purchasers in the United States, before application of 
discounts, rebates, or reductions in price.
(2)  LICENSURE.  (a)  No individual may act as a pharmaceutical representative 
in this state without being licensed by the commissioner as a pharmaceutical 
representative under this section. In order to obtain or renew a license, the 
individual shall apply to the commissioner in the form and manner prescribed by 
the commissioner.  The term of a license issued under this paragraph is one year 
and is renewable.  The application to obtain or renew a license shall include all of 
the following information:
1.  The applicant[s full name, residence address and telephone number, and 
business address and telephone number.
2.  A description of the type of work in which the applicant will engage.
3.  The fee under s. 601.31 (1) (nv).
4. An attestation that the applicant meets the professional education 
requirements under sub. (3).
5.  Proof that the applicant has paid any assessed penalties and fees.
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6.  Any other information required by the commissioner by rule.
(b)  The pharmaceutical representative licensed under par. (a) shall notify the 
commissioner in writing of any change to the information submitted on an 
application under par. (a) or any material change to the pharmaceutical 
representative[s business operations or to any other information provided under 
this section.  The pharmaceutical representative shall provide the notification no 
later than 4 business days after the change or material change occurs.
(c)  A pharmaceutical representative licensed under par. (a) shall display the 
pharmaceutical representative[s license during each visit with a health care 
professional.
(3)  PROFESSIONAL EDUCATION REQUIREMENTS .  (a)  In order to become initially 
licensed under sub. (2) (a), a pharmaceutical representative shall complete a 
professional education course approved by the commissioner. A pharmaceutical 
representative shall, upon request, provide the commissioner with proof that he or 
she has completed an approved professional education course.
(b) In order to renew a license under sub. (2) (a), a pharmaceutical 
representative shall complete a minimum of 5 hours of continuing professional 
education courses.  A pharmaceutical representative who has renewed a license 
under sub. (2) (a) shall, upon request, provide the commissioner with proof that he 
or she has completed a minimum of 5 hours of continuing professional education 
courses.
(c)  The professional education coursework required under pars. (a) and (b) 
shall include training in ethical standards, whistleblower protections, laws and 
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rules applicable to pharmaceutical marketing, and other subjects that the 
commissioner identifies by rule.
(d) The commissioner shall regularly designate courses that fulfill the 
requirements under this subsection and publish a list of the designated courses.
(e)  The professional education coursework required under this subsection may 
not be provided by the employer of a pharmaceutical representative or be funded, in 
any way, by the pharmaceutical industry or a 3rd party funded by the 
pharmaceutical industry.  A provider of a course designated under par. (d) shall 
disclose any conflict of interest to the commissioner.
(4)  DISCLOSURE TO COMMISSIONER.  (a)  No later than June 1 of each year, a 
pharmaceutical representative licensed under sub. (2) (a) shall provide to the 
commissioner, in the manner prescribed by the commissioner, all of the following 
information from the previous calendar year:
1.  The total number of times the pharmaceutical representative contacted 
health care professionals in this state and the specialties of the health care 
professionals contacted.
2.  For each contact with a health care professional in this state, the location 
and duration of the contact, the pharmaceuticals for which the pharmaceutical 
representative provided information, and the value of any item, including a product 
sample, compensation, material, or gift, provided to the health care professional.
(b)  The commissioner shall publish the information received under par. (a) on 
the commissioner[s website in a manner in which individual health care 
professionals are not identifiable by name or other identifiers.
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(5)  DISCLOSURE TO HEALTH CARE PROFESSIONALS.  During each contact with a 
health care professional, a pharmaceutical representative licensed under sub. (2) 
(a) shall disclose the wholesale acquisition cost of any pharmaceutical for which the 
pharmaceutical representative provides information and the names of at least 3 
generic prescription drugs from the same therapeutic class or, if 3 are not available, 
as many as are available for prescriptive use.
(6)  ETHICAL STANDARDS. The commissioner shall promulgate rules that 
contain ethical standards for pharmaceutical representatives and shall publish the 
ethical standards on the commissioner[s website.  A pharmaceutical representative 
licensed under sub. (2) (a) shall comply with the ethical standards contained in the 
rules and may not do any of the following:
(a) Engage in deceptive or misleading marketing of a pharmaceutical, 
including the knowing concealment, suppression, omission, misleading 
representation, or misstatement of a material fact.
(b)  Use a title or designation that could reasonably lead a licensed health care 
professional, or an employee or representative of a licensed health care professional, 
to believe that the pharmaceutical representative is licensed to practice medicine, 
nursing, dentistry, optometry, pharmacy, or other similar health occupation in this 
state unless the pharmaceutical representative holds that license to practice.
(c)  Attend a patient examination without the patient[s consent.
(7)  ENFORCEMENT . (a) Any individual who violates this section shall be 
required to forfeit not less than $1,000 nor more than $3,000 for each offense.  Each 
day of continued violation constitutes a separate offense.
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(b)  The commissioner may suspend or revoke the license of a pharmaceutical 
representative who violates this section.  A suspended or revoked license may not be 
reinstated until the pharmaceutical representative remedies all violations related 
to the suspension or revocation and pays all assessed penalties and fees. A 
pharmaceutical representative whose license is revoked for any cause may not be 
issued a license under sub. (2) (a) until at least 2 years after the date of revocation.
(c) A health care professional who meets with a pharmaceutical 
representative who does not display the pharmaceutical representative[s license or 
share the information required under sub. (5) may report the pharmaceutical 
representative to the commissioner.
(8)  RULES. The commissioner may promulgate rules to implement this 
section.
SECTION 16.  601.57 of the statutes is created to read:
601.57 Pharmacy services administrative organizations .  (1)  
DEFINITIONS.  In this section:
(a)  XAdministrative serviceY means any of the following:
1.  Assisting with claims.
2.  Assisting with audits.
3.  Providing centralized payment.
4.  Performing certification in a specialized care program.
5.  Providing compliance support.
6.  Setting flat fees for generic drugs.
7.  Assisting with store layout.
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8.  Managing inventory.
9.  Providing marketing support.
10. Providing management and analysis of payment and drug dispensing 
data.
11.  Providing resources for retail cash cards.
(b)  XIndependent pharmacyY means a pharmacy operating in this state that is 
licensed under s. 450.06 or 450.065 and is under common ownership with no more 
than 2 other pharmacies.
(c)  XPharmacy benefit managerY has the meaning given in s. 632.865 (1) (c).
(d)  XPharmacy services administrative organizationY means an entity 
operating in this state that does all of the following:
1. Contracts with an independent pharmacy to conduct business on the 
independent pharmacy[s behalf with a 3rd-party payer.
2.  Provides at least one administrative service to an independent pharmacy 
and negotiates and enters into a contract with a 3rd-party payer or pharmacy 
benefit manager on behalf of the independent pharmacy.
(e)  XThird-party payerY means an entity, including a plan sponsor, health 
maintenance organization, or insurer, operating in this state that pays or insures 
health, medical, or prescription drug expenses on behalf of beneficiaries.
(2)  LICENSURE. (a) No person may operate as a pharmacy services 
administrative organization in this state without being licensed by the 
commissioner as a pharmacy services administrative organization under this 
section. In order to obtain or renew a license, the person shall apply to the 
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commissioner in the form and manner prescribed by the commissioner. The 
application shall include all of the following:
1.  The name, address, telephone number, and federal employer identification 
number of the applicant.
2.  The name, business address, and telephone number of a contact person for 
the applicant.
3.  The fee under s. 601.31 (1) (nw).
4.  Evidence of financial responsibility of at least $1,000,000.
5.  Any other information required by the commissioner by rule.
(b)  The term of a license issued under par. (a) shall be 2 years from the date of 
issuance.
(3)  DISCLOSURE TO THE COMMISSIONER. (a) A pharmacy services 
administrative organization licensed under sub. (2) shall disclose to the 
commissioner the extent of any ownership or control of the pharmacy services 
administrative organization by an entity that does any of the following:
1.  Provides pharmacy services.
2.  Provides prescription drug or device services.
3. Manufactures, sells, or distributes prescription drugs, biologicals, or 
medical devices.
(b)  A pharmacy services administrative organization licensed under sub. (2) 
shall notify the commissioner in writing within 5 days of any material change in its 
ownership or control relating to an entity described in par. (a).
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(4)  RULES. The commissioner may promulgate rules to implement this 
section.
SECTION 17.  601.575 of the statutes is created to read:
601.575 Prescription drug importation program.  (1) IMPORTATION 
PROGRAM REQUIREMENTS . The commissioner, in consultation with persons 
interested in the sale and pricing of prescription drugs and appropriate officials 
and agencies of the federal government, shall design and implement a prescription 
drug importation program for the benefit of residents of this state, that generates 
savings for residents, and that satisfies all of the following:
(a)  The commissioner shall designate a state agency to become a licensed 
wholesale distributor or to contract with a licensed wholesale distributor and shall 
seek federal certification and approval to import prescription drugs.
(b)  The program shall comply with relevant requirements of 21 USC 384, 
including safety and cost savings requirements.
(c) The program shall import prescription drugs from Canadian suppliers 
regulated under any appropriate Canadian or provincial laws.
(d) The program shall have a process to sample the purity, chemical 
composition, and potency of imported prescription drugs.
(e) The program shall import only those prescription drugs for which 
importation creates substantial savings for residents of this state and only those 
prescription drugs that are not brand-name drugs and that have fewer than 4 
competitor prescription drugs in the United States.
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(f)  The commissioner shall ensure that prescription drugs imported under the 
program are not distributed, dispensed, or sold outside of this state.
(g)  The program shall ensure all of the following:
1.  Participation by any pharmacy or health care provider in the program is 
voluntary.
2.  Any pharmacy or health care provider participating in the program has the 
appropriate license or other credential in this state.
3.  Any pharmacy or health care provider participating in the program charges 
a consumer or health plan the actual acquisition cost of the imported prescription 
drug that is dispensed.
(h) The program shall ensure that a payment by a health plan or health 
insurance policy for a prescription drug imported under the program reimburses no 
more than the actual acquisition cost of the imported prescription drug that is 
dispensed.
(i)  The program shall ensure that any health plan or health insurance policy 
participating in the program does all of the following:
1. Maintains a formulary and claims payment system with current 
information on prescription drugs imported under the program.
2.  Bases cost-sharing amounts for participants or insureds under the plan or 
policy on no more than the actual acquisition cost of the prescription drug imported 
under the program that is dispensed to the participant or insured.
3. Demonstrates to the commissioner or a state agency designated by the 
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commissioner how premiums under the plan or policy are affected by savings on 
prescription drugs imported under the program.
(j)  Any wholesale distributor importing prescription drugs under the program 
shall limit its profit margin to the amount established by the commissioner or a 
state agency designated by the commissioner.
(k)  The program may not import any generic prescription drug that would 
violate federal patent laws on branded products in the United States.
(L)  The program shall comply with tracking and tracing requirements of 21 
USC 360eee and 360eee-1, to the extent practical and feasible, before the 
prescription drug to be imported comes into the possession of this state[s wholesale 
distributor and fully after the prescription drug to be imported is in the possession 
of this state[s wholesale distributor.
(m) The program shall establish a fee or other mechanism to finance the 
program that does not jeopardize significant savings to residents of this state.
(n)  The program shall have an audit function that ensures all of the following:
1.  The commissioner has a sound methodology to determine the most cost-
effective prescription drugs to include in the program.
2.  The commissioner has a process in place to select Canadian suppliers that 
are high quality, high performing, and in full compliance with Canadian laws.
3.  Prescription drugs imported under the program are pure, unadulterated, 
potent, and safe.
4.  The program is complying with the requirements of this subsection.
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5.  The program is adequately financed to support administrative functions of 
the program while generating significant cost savings to residents of this state.
6.  The program does not put residents of this state at a higher risk than if the 
program did not exist.
7.  The program provides and is projected to continue to provide substantial 
cost savings to residents of this state.
(2) ANTICOMPETITIVE BEHAVIOR.  The commissioner, in consultation with the 
attorney general, shall identify the potential for and monitor anticompetitive 
behavior in industries affected by a prescription drug importation program.
(3)  APPROVAL OF PROGRAM DESIGN; CERTIFICATION.  No later than the first day 
of the 7th month beginning after the effective date of this subsection .... [LRB 
inserts date], the commissioner shall submit to the joint committee on finance a 
report that includes the design of the prescription drug importation program in 
accordance with this section. The commissioner may not submit the proposed 
program to the federal department of health and human services unless the joint 
committee on finance approves the proposed program.  Within 14 days of the date of 
approval by the joint committee on finance of the proposed program, the 
commissioner shall submit to the federal department of health and human services 
a request for certification of the approved program.
(4) IMPLEMENTATION OF CERTIFIED PROGRAM.  After the federal department of 
health and human services certifies the prescription drug importation program 
submitted under sub. (3), the commissioner shall begin implementation of the 
program, and the program shall be fully operational by 180 days after the date of 
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certification by the federal department of health and human services. The 
commissioner shall do all of the following to implement the program to the extent 
the action is in accordance with other state laws and the certification by the federal 
department of health and human services:
(a)  Become a licensed wholesale distributor, designate another state agency to 
become a licensed wholesale distributor, or contract with a licensed wholesale 
distributor.
(b)  Contract with one or more Canadian suppliers that meet the criteria in 
sub. (1) (c) and (n).
(c)  Create an outreach and marketing plan to communicate with and provide 
information to health plans and health insurance policies, employers, pharmacies, 
health care providers, and residents of this state on participating in the program.
(d)  Develop and implement a registration process for health plans and health 
insurance policies, pharmacies, and health care providers interested in 
participating in the program.
(e)  Create a publicly accessible source for listing prices of prescription drugs 
imported under the program.
(f)  Create, publicize, and implement a method of communication to promptly 
answer questions from and address the needs of persons affected by the 
implementation of the program before the program is fully operational.
(g)  Establish the audit functions under sub. (1) (n) with a timeline to complete 
each audit function every 2 years.
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(h) Conduct any other activities determined by the commissioner to be 
important to successful implementation of the program.
(5) REPORT.  By January 1 and July 1 of each year, the commissioner shall 
submit to the joint committee on finance a report including all of the following:
(a)  A list of prescription drugs included in the prescription drug importation 
program under this section.
(b)  The number of pharmacies, health care providers, and health plans and 
health insurance policies participating in the prescription drug importation 
program under this section.
(c)  The estimated amount of savings to residents of this state, health plans 
and health insurance policies, and employers resulting from the implementation of 
the prescription drug importation program under this section reported from the 
date of the previous report under this subsection and from the date the program 
was fully operational.
(d)  Findings of any audit functions under sub. (1) (n) completed since the date 
of the previous report under this subsection.
(6)  RULE MAKING. The commissioner may promulgate any rules necessary to 
implement this section.
SECTION 18.  Subchapter VI of chapter 601 [precedes 601.78] of the statutes is 
created to read:
CHAPTER 601
SUBCHAPTER VI
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PRESCRIPTION DRUG  
AFFORDABILITY REVIEW BOARD
601.78  Definitions.  In this subchapter:
(1) XBiologicY means a drug that is produced or distributed in accordance with 
a biologics license application approved under 21 CFR 601.20.
(2) XBiosimilarY means a drug that is produced or distributed in accordance 
with a biologics license application approved under 42 USC 262 (k) (3).
(3) XBoardY means the prescription drug affordability review board 
established under s. 15.735 (1).
(4) XBrand name drugY means a drug that is produced or distributed in 
accordance with an original new drug application approved under 21 USC 355 (c), 
other than an authorized generic drug, as defined in 42 CFR 447.502.
(5) XDrug productY means a brand name drug, a generic drug, a biologic, a 
biosimilar, or an over-the-counter drug.
(6) XFinancial benefitY includes an honorarium, a fee, a stock, the value of the 
stock holdings of a member of the board or any immediate family member, and any 
direct financial benefit deriving from the finding of a review conducted under s. 
601.79.
(7) XGeneric drugY means any of the following:
(a) A retail drug that is marketed or distributed in accordance with an 
abbreviated new drug application approved under 21 USC 355 (j).
(b)  An authorized generic drug, as defined in 42 CFR 447.502.
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(c) A drug that entered the market prior to 1962 and was not originally 
marketed under a new drug application.
(8) XImmediate family memberY means a spouse, grandparent, parent, 
sibling, child, stepchild, or grandchild or the spouse of a grandparent, parent, 
sibling, child, stepchild, or grandchild.
(9) XManufacturerY means an entity that does all of the following:
(a)  Engages in the manufacture of a drug product or enters into a lease with 
another manufacturer to market and distribute a prescription drug product under 
the entity[s own name.
(b) Sets or changes the wholesale acquisition cost of the drug product or 
prescription drug product described in par. (a).
(10) XOver-the-counter drugY means a drug intended for human use that does 
not require a prescription and meets the requirements of 21 CFR parts 328 to 369.
(11)  XPharmacy benefit managerY has the meaning given in s. 632.865 (1) (c).
(12) XPrescription drug productY means a brand name drug, a generic drug, a 
biologic, or a biosimilar.
601.785  Prescription drug affordability review board.  (1)  MISSION.  
The purpose of the board is to protect state residents, the state, local governments, 
health plans, health care providers, pharmacies licensed in this state, and other 
stakeholders of the health care system in this state from the high costs of 
prescription drug products.
(2)  POWERS AND DUTIES.  (a)  The board shall do all of the following:
1.  Meet in open session at least 4 times per year to review prescription drug 
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product pricing information, except that the chair may cancel or postpone a meeting 
if there is no business to transact.
2. To the extent practicable, access and assess pricing information for 
prescription drug products by doing all of the following:
a. Accessing and assessing information from other states by entering into 
memoranda of understanding with other states to which manufacturers report 
pricing information.
b.  Assessing spending for specific prescription drug products in this state.
c.  Accessing other available pricing information.
(b)  The board may do any of the following:
1.  Promulgate rules for the administration of this subchapter.
2. Enter into a contract with an independent 3rd party for any service 
necessary to carry out the powers and duties of the board as described in this 
subsection.  Unless written permission is granted by the board, a person with whom 
the board contracts may not release, publish, or otherwise use any information to 
which the person has access under the contract.
(c)  The board shall establish and maintain a website to provide public notices 
and make meeting materials available under sub. (3) (a) and to disclose conflicts of 
interest under sub. (4) (d).
(3)  MEETING REQUIREMENTS . (a)  Pursuant to s. 19.84, the board shall provide 
public notice of each board meeting at least 2 weeks prior to the meeting and shall 
make the materials for each meeting publicly available at least one week prior to 
the meeting.
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(b)  Notwithstanding s. 19.84 (2), the board shall provide an opportunity for 
public comment at each open meeting and shall provide the public with the 
opportunity to provide written comments on pending decisions of the board.
(c)  Notwithstanding subch. V of ch. 19, any portion of a meeting of the board 
concerning proprietary data and information shall be conducted in closed session 
and shall in all respects remain confidential.
(d)  The board may allow expert testimony at any meeting, including when the 
board meets in closed session.
(4)  CONFLICTS OF INTEREST.  (a)  A member of the board shall recuse himself 
or herself from a decision by the board relating to a prescription drug product if the 
member or an immediate family member has received or could receive any of the 
following:
1.  A direct financial benefit deriving from a determination, or a finding of a 
study or review, by the board relating to the prescription drug product.
2.  A financial benefit in excess of $5,000 in a calendar year from any person 
who owns, manufactures, or provides a prescription drug product to be studied or 
reviewed by the board.
(b)  A conflict of interest under this subsection shall be disclosed by the board 
when hiring board staff, by the appointing authority when appointing members to 
the board, and by the board when a member of the board is recused from any 
decision relating to a review of a prescription drug product.
(c)  A conflict of interest under this subsection shall be disclosed no later than 
5 days after the conflict is identified, except that, if the conflict is identified within 
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5 days of an open meeting of the board, the conflict shall be disclosed prior to the 
meeting.
(d)  The board shall disclose a conflict of interest under this subsection on the 
board[s website unless the chair of the board recuses the member from a final 
decision relating to a review of the prescription drug product.  The disclosure shall 
include the type, nature, and magnitude of the interests of the member involved.
(e)  A member of the board or a 3rd-party contractor may not accept any gift or 
donation of services or property that indicates a potential conflict of interest or has 
the appearance of biasing the work of the board.
601.79  Drug cost affordability review.  (1)  IDENTIFICATION OF DRUGS.  
The board shall identify prescription drug products that are any of the following:
(a) A brand name drug or biologic that, as adjusted annually to reflect 
adjustments to the U.S. consumer price index for all urban consumers, U.S. city 
average, as determined by the U.S. department of labor, has a launch wholesale 
acquisition cost of at least $30,000 per year or course of treatment.
(b) A brand name drug or biologic that, as adjusted annually to reflect 
adjustments to the U.S. consumer price index for all urban consumers, U.S. city 
average, as determined by the U.S. department of labor, has a wholesale acquisition 
cost that has increased at least $3,000 during a 12-month period.
(c)  A biosimilar that has a launch wholesale acquisition cost that is not 15 
percent or more lower than the referenced brand biologic at the time the biosimilar 
is launched.
(d)  A generic drug that has a wholesale acquisition cost, as adjusted annually 
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to reflect adjustments to the U.S. consumer price index for all urban consumers, 
U.S. city average, as determined by the U.S. department of labor, that meets all of 
the following conditions:
1.  Is at least $100 for a supply lasting a patient for a period of 30 consecutive 
days based on the recommended dosage approved for labeling by the federal food 
and drug administration, a supply lasting a patient for a period of fewer than 30 
days based on the recommended dosage approved for labeling by the federal food 
and drug administration, or one unit of the drug if the labeling approved by the 
federal food and drug administration does not recommend a finite dosage.
2.  Increased by at least 200 percent during the preceding 12-month period, as 
determined by the difference between the resulting wholesale acquisition cost and 
the average of the wholesale acquisition cost reported over the preceding 12 
months.
(e)  Other prescription drug products, including drugs to address public health 
emergencies, that may create affordability challenges for the health care system 
and patients in this state.
(2) AFFORDABILITY REVIEW.  (a)  After identifying prescription drug products 
under sub. (1), the board shall determine whether to conduct an affordability 
review for each identified prescription drug product by seeking stakeholder input 
about the prescription drug product and considering the average patient cost share 
of the prescription drug product.
(b)  The information used to conduct an affordability review under par. (a) may 
include any document and research related to the manufacturer[s selection of the 
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introductory price or price increase of the prescription drug product, including life 
cycle management, net average price in this state, market competition and context, 
projected revenue, and the estimated value or cost-effectiveness of the prescription 
drug product.
(c)  The failure of a manufacturer to provide the board with information for an 
affordability review under par. (b) does not affect the authority of the board to 
conduct the review.
(3)  AFFORDABILITY CHALLENGE.  When conducting an affordability review of a 
prescription drug product under sub. (2), the board shall determine whether use of 
the prescription drug product that is fully consistent with the labeling approved by 
the federal food and drug administration or standard medical practice has led or 
will lead to an affordability challenge for the health care system in this state, 
including high out-of-pocket costs for patients. To the extent practicable, in 
determining whether a prescription drug product has led or will lead to an 
affordability challenge, the board shall consider all of the following factors:
(a)  The wholesale acquisition cost for the prescription drug product sold in 
this state.
(b) The average monetary price concession, discount, or rebate the 
manufacturer provides, or is expected to provide, to health plans in this state as 
reported by manufacturers and health plans, expressed as a percentage of the 
wholesale acquisition cost for the prescription drug product under review.
(c) The total amount of the price concessions, discounts, and rebates the 
manufacturer provides to each pharmacy benefit manager for the prescription drug 
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product under review, as reported by the manufacturer and pharmacy benefit 
manager and expressed as a percentage of the wholesale acquisition cost.
(d) The price at which therapeutic alternatives to the prescription drug 
product have been sold in this state.
(e)  The average monetary concession, discount, or rebate the manufacturer 
provides or is expected to provide to health plan payors and pharmacy benefit 
managers in this state for therapeutic alternatives to the prescription drug product.
(f)  The costs to health plans based on patient access consistent with labeled 
indications by the federal food and drug administration and recognized standard 
medical practice.
(g)  The impact on patient access resulting from the cost of the prescription 
drug product relative to insurance benefit design.
(h) The current or expected dollar value of drug-specific patient access 
programs that are supported by the manufacturer.
(i)  The relative financial impacts to health, medical, or social services costs 
that can be quantified and compared to baseline effects of existing therapeutic 
alternatives to the prescription drug product.
(j)  The average patient copay or other cost sharing for the prescription drug 
product in this state.
(k)  Any information a manufacturer chooses to provide.
(L)  Any other factors as determined by the board by rule.
(4) UPPER PAYMENT LIMIT.  (a)  If the board determines under sub. (3) that use 
of a prescription drug product has led or will lead to an affordability challenge, the 
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board shall establish an upper payment limit for the prescription drug product after 
considering all of the following:
1.  The cost of administering the drug.
2.  The cost of delivering the drug to consumers.
3.  Other relevant administrative costs related to the drug.
(b) For a prescription drug product identified in sub. (1) (b) or (d) 2., the board 
shall solicit information from the manufacturer regarding the price increase.  To 
the extent that the price increase is not a result of the need for increased 
manufacturing capacity or other effort to improve patient access during a public 
health emergency, the board shall establish an upper payment limit under par. (a) 
that is equal to the cost to consumers prior to the price increase.
(c) 1.  An upper payment limit established under par. (a) shall apply to all 
purchases and payor reimbursements of the prescription drug product dispensed or 
administered to individuals in this state in person, by mail, or by other means.
2. Notwithstanding subd. 1., while state-sponsored and state-regulated 
health plans and health programs shall limit drug reimbursements and drug 
payment to no more than the upper payment limit established under par. (a), a plan 
subject to the Employee Retirement Income Security Act of 1974 or Part D of 
Medicare under 42 USC 1395w-101 et seq. may choose to reimburse more than the 
upper payment limit.  A provider who dispenses and administers a prescription 
drug product in this state to an individual in this state may not bill a payor more 
than the upper payment limit to the patient regardless of whether a plan subject to 
the Employee Retirement Income Security Act of 1974 or Part D of Medicare under 
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42 USC 1395w-101 et seq. chooses to reimburse the provider above the upper 
payment limit.
(5)  PUBLIC INSPECTION. Information submitted to the board under this 
section shall be open to public inspection only as provided under ss. 19.31 to 19.39.
(6) NO PROHIBITION ON MARKETING.  Nothing in this section may be construed 
to prevent a manufacturer from marketing a prescription drug product approved by 
the federal food and drug administration while the prescription drug product is 
under review by the board.
(7)  APPEALS.  A person aggrieved by a decision of the board may request an 
appeal of the decision no later than 30 days after the board makes the 
determination.  The board shall hear the appeal and make a final decision no later 
than 60 days after the appeal is requested.  A person aggrieved by a final decision of 
the board may petition for judicial review in a court of competent jurisdiction.
SECTION 19.  609.83 of the statutes is amended to read:
609.83 Coverage of drugs and devices. Limited service health 
organizations, preferred provider plans, and defined network plans are subject to 
ss. 632.853, 632.861, and 632.895 (6) (b), (16t), and (16v).
SECTION 20.  632.865 (2m) of the statutes is created to read:
632.865 (2m)  FIDUCIARY DUTY AND DISCLOSURES TO HEALTH BENEFIT PLAN 
SPONSORS.  (a)  A pharmacy benefit manager owes a fiduciary duty to the health 
benefit plan sponsor to act according to the health benefit plan sponsor[s 
instructions and in the best interests of the health benefit plan sponsor.
(b)  A pharmacy benefit manager shall annually provide, no later than the 
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date and using the method prescribed by the commissioner by rule, the health 
benefit plan sponsor all of the following information from the previous calendar 
year:
1.  The indirect profit received by the pharmacy benefit manager from owning 
any interest in a pharmacy or service provider.
2.  Any payment made by the pharmacy benefit manager to a consultant or 
broker who works on behalf of the health benefit plan sponsor.
3. From the amounts received from all drug manufacturers, the amounts 
retained by the pharmacy benefit manager, and not passed through to the health 
benefit plan sponsor, that are related to the health benefit plan sponsor[s claims or 
bona fide service fees.
4.  The amounts, including pharmacy access and audit recovery fees, received 
from all pharmacies that are in the pharmacy benefit manager[s network or have a 
contract to be in the network and, from these amounts, the amount retained by the 
pharmacy benefit manager and not passed through to the health benefit plan 
sponsor.
SECTION 21.  632.868 of the statutes is created to read:
632.868  Insulin safety net programs.  (1)  DEFINITIONS.  In this section:
(a)  XManufacturerY means a person engaged in the manufacturing of insulin 
that is self-administered on an outpatient basis.
(b)  XNavigatorY has the meaning given in s. 628.90 (3).
(c)  XPatient assistance programY means a program established by a 
manufacturer under sub. (3) (a).
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(d)  XPharmacyY means an entity licensed under s. 450.06 or 450.065.
(e)  XUrgent need of insulinY means having less than a 7-day supply of insulin 
readily available for use and needing insulin in order to avoid the likelihood of 
suffering a significant health consequence.
(f)  XUrgent need safety net programY means a program established by a 
manufacturer under sub. (2) (a).
(2)  URGENT NEED SAFETY NET PROGRAM.  (a)  Establishment of program.  No 
later than July 1, 2026, each manufacturer shall establish an urgent need safety net 
program to make insulin available in accordance with this subsection to individuals 
who meet the eligibility requirements under par. (b).
(b)  Eligible individual.  An individual shall be eligible to receive insulin under 
an urgent need safety net program if all of the following conditions are met:
1.  The individual is in urgent need of insulin.
2.  The individual is a resident of this state.
3.  The individual is not receiving public assistance under ch. 49.
4.  The individual is not enrolled in prescription drug coverage through an 
individual or group health plan that limits the total cost sharing amount, including 
copayments, deductibles, and coinsurance, that an enrollee is required to pay for a 
30-day supply of insulin to no more than $75, regardless of the type or amount of 
insulin prescribed.
5.  The individual has not received insulin under an urgent need safety net 
program within the previous 12 months, except as allowed under par. (d).
(c)  Provision of insulin under an urgent need safety net program.  1.  In order 
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to receive insulin under an urgent need safety net program, an individual who 
meets the eligibility requirements under par. (b) shall provide a pharmacy with all 
of the following:
a.  A completed application, on a form prescribed by the commissioner that 
shall include an attestation by the individual, or the individual[s parent or legal 
guardian if the individual is under the age of 18, that the individual meets all of the 
eligibility requirements under par. (b).
b.  A valid insulin prescription.
c. A valid Wisconsin driver[s license or state identification card. If the 
individual is under the age of 18, the individual[s parent or legal guardian shall 
meet this requirement.
2.  Upon receipt of the information described in subd. 1. a. to c., the pharmacist 
shall dispense a 30-day supply of the prescribed insulin to the individual. The 
pharmacy shall also provide the individual with the information sheet described in 
sub. (8) (b) 2. and the list of navigators described in sub. (8) (c).  The pharmacy may 
collect a copayment, not to exceed $35, from the individual to cover the pharmacy[s 
costs of processing and dispensing the insulin. The pharmacy shall notify the 
health care practitioner who issued the prescription no later than 72 hours after the 
insulin is dispensed.
3. A pharmacy that dispenses insulin under subd. 2. may submit to the 
manufacturer, or the manufacturer[s vendor, a claim for payment that is in 
accordance with the national council for prescription drug programs[ standards for 
electronic claims processing, except that no claim may be submitted if the 
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manufacturer agrees to send the pharmacy a replacement of the same insulin in 
the amount dispensed. If the pharmacy submits an electronic claim, the 
manufacturer or vendor shall reimburse the pharmacy in an amount that covers 
the pharmacy[s acquisition cost.
4.  A pharmacy that dispenses insulin under subd. 2. shall retain a copy of the 
application form described in subd. 1. a.
(d)  Eligibility of certain individuals.  An individual who has applied for public 
assistance under ch. 49 but for whom a determination of eligibility has not been 
made or whose coverage has not become effective or an individual who has an 
appeal pending under sub. (3) (c) 4. may access insulin under this subsection if the 
individual is in urgent need of insulin.  To access a 30-day supply of insulin, the 
individual shall attest to the pharmacy that the individual is described in this 
paragraph and comply with par. (c) 1.
(3)  PATIENT ASSISTANCE PROGRAM.  (a)  Establishment of program.  No later 
than July 1, 2026, each manufacturer shall establish a patient assistance program 
to make insulin available in accordance with this subsection to individuals who 
meet the eligibility requirements under par. (b). Under the patient assistance 
program, the manufacturer shall do all of the following:
1. Provide the commissioner with information regarding the patient 
assistance program, including contact information for individuals to call for 
assistance in accessing the patient assistance program.
2.  Provide a hotline for individuals to call or access between 8 a.m. and 10 p.m. 
on weekdays and between 10 a.m. and 6 p.m. on Saturdays.
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3. List the eligibility requirements under par. (b) on the manufacturer[s 
website.
4. Maintain the privacy of all information received from an individual 
applying for or participating in the patient assistance program and not sell, share, 
or disseminate the information unless required under this section or authorized, in 
writing, by the individual.
(b)  Eligible individual.  An individual shall be eligible to receive insulin under 
a patient assistance program if all of the following conditions are met:
1.  The individual is a resident of this state.
2.  The individual, or the individual[s parent or legal guardian if the individual 
is under the age of 18, has a valid Wisconsin driver[s license or state identification 
card.
3.  The individual has a valid insulin prescription.
4.  The family income of the individual does not exceed 400 percent of the 
poverty line as defined and revised annually under 42 USC 9902 (2) for a family the 
size of the individual[s family.
5.  The individual is not receiving public assistance under ch. 49.
6.  The individual is not eligible to receive health care through a federally 
funded program or receive prescription drug benefits through the U.S. department 
of veterans affairs, except that this subdivision does not apply to an individual who 
is enrolled in a policy under Part D of Medicare under 42 USC 1395w-101 et seq. if 
the individual has spent at least $1,000 on prescription drugs in the current 
calendar year.
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7.  The individual is not enrolled in prescription drug coverage through an 
individual or group health plan that limits the total cost sharing amount, including 
copayments, deductibles, and coinsurance, that an enrollee is required to pay for a 
30-day supply of insulin to no more than $75, regardless of the type or amount of 
insulin needed.
(c)  Application for patient assistance program.  1.  An individual may apply to 
participate in a patient assistance program by filing an application with the 
manufacturer that established the patient assistance program, the individual[s 
health care practitioner if the practitioner participates in the patient assistance 
program, or a navigator included on the list under sub. (8) (c). A health care 
practitioner or navigator shall immediately submit the application to the 
manufacturer.  Upon receipt of an application, the manufacturer shall determine 
the individual[s eligibility under par. (b) and, except as provided in subd. 2., notify 
the individual of the determination no later than 10 days after receipt of the 
application.
2. If necessary to determine the individual[s eligibility under par. (b), the 
manufacturer may request additional information from an individual who has filed 
an application under subd. 1. no later than 5 days after receipt of the application.  
Upon receipt of the additional information, the manufacturer shall determine the 
individual[s eligibility under par. (b) and notify the individual of the determination 
no later than 3 days after receipt of the requested information.
3.  Except as provided in subd. 5., if the manufacturer determines under subd. 
1. or 2. that the individual is eligible for the patient assistance program, the 
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manufacturer shall provide the individual with a statement of eligibility. The 
statement of eligibility shall be valid for 12 months and may be renewed upon a 
determination by the manufacturer that the individual continues to meet the 
eligibility requirements under par. (b).
4.  If the manufacturer determines under subd. 1. or 2. that the individual is 
not eligible for the patient assistance program, the manufacturer shall provide the 
reason for the determination in the notification under subd. 1. or 2.  The individual 
may appeal the determination by filing an appeal with the commissioner that shall 
include all of the information provided to the manufacturer under subds. 1. and 2.  
The commissioner shall establish procedures for deciding appeals under this 
subdivision.  The commissioner shall issue a decision no later than 10 days after the 
appeal is filed, and the commissioner[s decision shall be final.  If the commissioner 
determines that the individual meets the eligibility requirements under par. (b), the 
manufacturer shall provide the individual with the statement of eligibility 
described in subd. 3.
5.  In the case of an individual who has prescription drug coverage through an 
individual or group health plan, if the manufacturer determines under subd. 1. or 2. 
that the individual is eligible for the patient assistance program but also 
determines that the individual[s insulin needs are better addressed through the use 
of the manufacturer[s copayment assistance program rather than the patient 
assistance program, the manufacturer shall inform the individual of the 
determination and provide the individual with the necessary coupons to submit to 
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a pharmacy.  The individual may not be required to pay more than the copayment 
amount specified in par. (d) 2.
(d)  Provision of insulin under a patient assistance program.  1.  Upon receipt 
from an individual of the eligibility statement described in par. (c) 3. and a valid 
insulin prescription, a pharmacy shall submit an order containing the name of the 
insulin and daily dosage amount to the manufacturer.  The pharmacy shall include 
with the order the pharmacy[s name, shipping address, office telephone number, 
fax number, email address, and contact name, as well as any days or times when 
deliveries are not accepted by the pharmacy.
2.  Upon receipt of an order meeting the requirements under subd. 1., the 
manufacturer shall send the pharmacy a 90-day supply of insulin, or lesser amount 
if requested in the order, at no charge to the individual or pharmacy.  The pharmacy 
shall dispense the insulin to the individual associated with the order.  The insulin 
shall be dispensed at no charge to the individual, except that the pharmacy may 
collect a copayment from the individual to cover the pharmacy[s costs for processing 
and dispensing in an amount not to exceed $50 for each 90-day supply of insulin.  
The pharmacy may not seek reimbursement from the manufacturer or a 3rd-party 
payer.
3.  The pharmacy may submit a reorder to the manufacturer if the individual[s 
eligibility statement described in par. (c) 3. has not expired.  The reorder shall be 
treated as an order for purposes of subd. 2.
4.  Notwithstanding subds. 2. and 3., a manufacturer may send the insulin 
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directly to the individual if the manufacturer provides a mail-order service option, 
in which case the pharmacy may not collect a copayment from the individual.
(4)  EXCEPTIONS. (a)  This section does not apply to a manufacturer that shows 
to the commissioner[s satisfaction that the manufacturer[s annual gross revenue 
from insulin sales in this state does not exceed $2,000,000.
(b)  A manufacturer may not be required to make an insulin product available 
under sub. (2) or (3) if the wholesale acquisition cost of the insulin product does not 
exceed $8, as adjusted annually based on the U.S. consumer price index for all 
urban consumers, U.S. city average, per milliliter or the applicable national council 
for prescription drug programs[ plan billing unit.
(5)  CONFIDENTIALITY.  All medical information solicited or obtained by any 
person under this section shall be subject to the applicable provisions of state law 
relating to confidentiality of medical information, including s. 610.70.
(6) REIMBURSEMENT PROHIBITION. No person, including a manufacturer, 
pharmacy, pharmacist, or 3rd-party administrator, as part of participating in an 
urgent need safety net program or patient assistance program may request or seek, 
or cause another person to request or seek, any reimbursement or other 
compensation for which payment may be made in whole or in part under a federal 
health care program, as defined in 42 USC 1320a-7b (f).
(7)  REPORTS.  (a)  Annually, no later than March 1, each manufacturer shall 
report to the commissioner all of the following information for the previous calendar 
year:
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1.  The number of individuals who received insulin under the manufacturer[s 
urgent need safety net program.
2. The number of individuals who sought assistance under the 
manufacturer[s patient assistance program and the number of individuals who 
were determined to be ineligible under sub. (3) (c) 4.
3.  The wholesale acquisition cost of the insulin provided by the manufacturer 
through the urgent need safety net program and patient assistance program.
(b) Annually, no later than April 1, the commissioner shall submit to the 
governor and the chief clerk of each house of the legislature, for distribution to the 
legislature under s. 13.172 (2), a report on the urgent need safety net programs and 
patient assistance programs that includes all of the following:
1.  The information provided to the commissioner under par. (a).
2.  The forfeitures assessed under sub. (9) during the previous calendar year, 
including the name of the manufacturer and amount of the forfeiture.
(8)  ADDITIONAL RESPONSIBILITIES OF COMMISSIONER.  (a)  Application form.  
The commissioner shall make the application form described in sub. (2) (c) 1. a. 
available on the office[s website and shall make the form available to pharmacies 
and health care providers who prescribe or dispense insulin, hospital emergency 
departments, urgent care clinics, and community health clinics.
(b)  Public outreach.  1.  The commissioner shall conduct public outreach to 
create awareness of the urgent need safety net programs and patient assistance 
programs.
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2.  The commissioner shall develop and make available on the office[s website 
an information sheet that contains all of the following information:
a.  A description of how to access insulin through an urgent need safety net 
program.
b. A description of how to access insulin through a patient assistance 
program.
c. Information on how to contact a navigator for assistance in accessing 
insulin through an urgent need safety net program or patient assistance program.
d. Information on how to contact the commissioner if a manufacturer 
determines that an individual is not eligible for a patient assistance program.
e.  A notification that an individual may contact the commissioner for more 
information or assistance in accessing ongoing affordable insulin options.
(c)  Navigators.  The commissioner shall develop a training program to provide 
navigators with information and the resources necessary to assist individuals in 
accessing appropriate long-term insulin options.  The commissioner shall compile a 
list of navigators that have completed the training program and are available to 
assist individuals in accessing affordable insulin coverage options.  The list shall be 
made available on the office[s website and to pharmacies and health care 
practitioners who dispense and prescribe insulin.
(d)  Satisfaction surveys.  1.  The commissioner shall develop and conduct a 
satisfaction survey of individuals who have accessed insulin through urgent need 
safety net programs and patient assistance programs. The survey shall ask 
whether the individual is still in need of a long-term solution for affordable insulin 
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and shall include questions about the individual[s satisfaction with all of the 
following, if applicable:
a.  Accessibility to urgent-need insulin.
b.  Adequacy of the information sheet and list of navigators received from the 
pharmacy.
c.  Helpfulness of a navigator.
d.  Ease of access in applying for a patient assistance program and receiving 
insulin from the pharmacy under the patient assistance program.
2. The commissioner shall develop and conduct a satisfaction survey of 
pharmacies that have dispensed insulin through urgent need safety net programs 
and patient assistance programs.  The survey shall include questions about the 
pharmacy[s satisfaction with all of the following, if applicable:
a.  Timeliness of reimbursement from manufacturers for insulin dispensed by 
the pharmacy under urgent need safety net programs.
b.  Ease in submitting insulin orders to manufacturers.
c.  Timeliness of receiving insulin orders from manufacturers.
3. The commissioner may contract with a nonprofit entity to develop and 
conduct the surveys under subds. 1. and 2. and to evaluate the survey results.
4.  No later than July 1, 2028, the commissioner shall submit to the governor 
and the chief clerk of each house of the legislature, for distribution to the legislature 
under s. 13.172 (2), a report on the results of the surveys under subds. 1. and 2.
(9)  PENALTY.  A manufacturer that fails to comply with this section may be 
required to forfeit up to $200,000 per month of noncompliance, with the maximum 
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forfeiture increasing to $400,000 per month if the manufacturer continues to be in 
noncompliance after 6 months and increasing to $600,000 per month if the 
manufacturer continues to be in noncompliance after one year.
SECTION 22.  632.869 of the statutes is created to read:
632.869  Reimbursement to federal drug pricing program 
participants.  (1)  In this section:
(a)  XCovered entityY means an entity described in 42 USC 256b (a) (4) (A), (D), 
(E), (J), or (N) that participates in the federal drug pricing program under 42 USC 
256b, a pharmacy of the entity, or a pharmacy contracted with the entity to 
dispense drugs purchased through the federal drug pricing program under 42 USC 
256b.
(b)  XPharmacy benefit managerY has the meaning given in s. 632.865 (1) (c).
(2)  No person, including a pharmacy benefit manager or 3rd-party payer, may 
do any of the following:
(a)  Reimburse a covered entity for a drug that is subject to an agreement 
under 42 USC 256b at a rate lower than that paid for the same drug to pharmacies 
that are not covered entities and have a similar prescription volume to that of the 
covered entity.
(b)  Assess a covered entity any fee, charge back, or other adjustment on the 
basis of the covered entity[s participation in the federal drug pricing program under 
42 USC 256b.
SECTION 23.  632.895 (6) (title) of the statutes is amended to read:
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632.895 (6) (title)  EQUIPMENT AND SUPPLIES FOR TREATMENT OF DIABETES; 
INSULIN.
SECTION 24.  632.895 (6) of the statutes is renumbered 632.895 (6) (a) and 
amended to read:
632.895 (6) (a)  Every disability insurance policy which that provides coverage 
of expenses incurred for treatment of diabetes shall provide coverage for expenses 
incurred by the installation and use of an insulin infusion pump, coverage for all 
other equipment and supplies, including insulin or any other prescription 
medication, used in the treatment of diabetes, and coverage of diabetic self-
management education programs. Coverage Except as provided in par. (b), 
coverage required under this subsection shall be subject to the same exclusions, 
limitations, deductibles, and coinsurance provisions of the policy as other covered 
expenses, except that insulin infusion pump coverage may be limited to the 
purchase of one pump per year and the insurer may require the insured to use a 
pump for 30 days before purchase.
SECTION 25.  632.895 (6) (b) of the statutes is created to read:
632.895 (6) (b) 1.  In this paragraph:
a.  XCost sharingY means the total of any deductible, copayment, or 
coinsurance amounts imposed on a person covered under a policy or plan.
b.  XSelf-insured health planY has the meaning given in s. 632.85 (1) (c).
2.  Every disability insurance policy and self-insured health plan that covers 
insulin and imposes cost sharing on prescription drugs may not impose cost sharing 
on insulin in an amount that exceeds $35 for a one-month supply of insulin.
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3.  Nothing in this paragraph prohibits a disability insurance policy or self-
insured health plan from imposing cost sharing on insulin in an amount less than 
the amount specified under subd. 2.  Nothing in this paragraph requires a disability 
insurance policy or self-insured health plan to impose any cost sharing on insulin.
SECTION 26. Nonstatutory provisions.
(1)  CENTRALIZED DRUG REPOSITORY.  The department of health services shall 
study and implement a centralized, physical drug repository program under s. 
255.056.
(2) PRESCRIPTION DRUG IMPORTATION PROGRAM. The commissioner of 
insurance shall submit the first report required under s. 601.575 (5) by the next 
January 1 or July 1, whichever is earliest, that is at least 180 days after the date the 
prescription drug importation program is fully operational under s. 601.575 (4).  
The commissioner of insurance shall include in the first 3 reports submitted under 
s. 601.575 (5) information on the implementation of the audit functions under s. 
601.575 (1) (n).
(3) PRESCRIPTION DRUG PURCHASING ENTITY. During the 2025-27 fiscal 
biennium, the office of the commissioner of insurance shall conduct a study on the 
viability of creating or implementing a state prescription drug purchasing entity.
(4) OFFICE OF PRESCRIPTION DRUG AFFORDABILITY. The office of the 
commissioner of insurance shall establish an office of prescription drug 
affordability in the office of the commissioner of insurance. The office of 
prescription drug affordability shall be responsible for prescription drug 
affordability programming within the office of the commissioner of insurance and 
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shall oversee the operations of the prescription drug affordability review board 
established under s. 15.735.
(5)  STAGGERED TERMS FOR PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD.  
Notwithstanding the length of terms specified for the members of the board under 
s. 15.735 (1) (b) to (e), 2 of the initial members shall be appointed for terms expiring 
on May 1, 2026; 2 of the initial members shall be appointed for terms expiring on 
May 1, 2027; 2 of the initial members shall be appointed for terms expiring on May 
1, 2028; and 2 of the initial members shall be appointed for terms expiring on May 
1, 2029.
SECTION 27.  Fiscal changes.
(1)  OFFICE OF PRESCRIPTION DRUG AFFORDABILITY.  In the schedule under s. 
20.005 (3) for the appropriation to the office of the commissioner of insurance under 
s. 20.145 (1) (g), the dollar amount for fiscal year 2026-27 is increased by $1,701,000 
to provide $500,000 in onetime implementation costs for establishing an office of 
prescription drug affordability in the office of the commissioner of insurance and 
$1,201,000 to increase the authorized FTE positions for the office of the 
commissioner of insurance by 16.0 PR positions within the office of prescription 
drug affordability, including 5.0 insurance examiners, 4.0 policy initiatives 
advisors, 2.0 attorneys, 1.0 insurance program manager, 2.0 insurance 
administrators, and 2.0 operations program associates.
SECTION 28. Effective dates. This act takes effect on the day after 
publication, except as follows:
(1)  COST-SHARING CAP ON INSULIN.  The treatment of ss. 609.83 and 632.895 
(6) (title), the renumbering and amendment of s. 632.895 (6), and the creation of s. 
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632.895 (6) (b) take effect on the first day of the 4th month beginning after 
publication.
(2) PHARMACY BENEFIT TOOL GRANTS. The treatment of ss. 20.005 (3) 
(schedule), 20.145 (1) (a), and 601.415 (14) takes effect on the day after publication, 
or on the 2nd day after publication of the 2025 biennial budget act, whichever is 
later.
(3)  LICENSURE OF PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS AND 
PHARMACEUTICAL REPRESENTATIVES .  The treatment of ss. 601.31 (1) (nv) and (nw), 
601.56, and 601.57 takes effect on the first day of the 7th month beginning after 
publication.
(4)  PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD.  The treatment of ss. 
15.07 (3) (bm) 7., 15.735, and 20.145 (1) (g) 4. and subch. VI of ch. 601 and SECTIONS 
26 (4) and (5) and 27 (1) of this act take effect on the first day of the 7th month 
beginning after publication or on the 2nd day after publication of the 2025 biennial 
budget act, whichever is later.
(END)
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