2025 - 2026 LEGISLATURE
LRB-2917/1
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2025 SENATE BILL 251
May 9, 2025 - Introduced by Senators DASSLER-ALFHEIM, KEYESKI, DRAKE,
HESSELBEIN, L. JOHNSON, LARSON, RATCLIFF, ROYS, SPREITZER and WIRCH,
cosponsored by Representatives SNODGRASS, MAYADEV, MCCARVILLE,
ANDERSON, ANDRACA, ARNEY, BARE, BROWN, CLANCY, DESMIDT, EMERSON,
FITZGERALD, J. JACOBSON, JOERS, JOHNSON, MADISON, MIRESSE, MOORE
OMOKUNDE, NEUBAUER, ORTIZ-VELEZ, PALMERI, PHELPS, PRADO, ROE,
SHEEHAN, SPAUDE, STROUD, STUBBS, SUBECK, TENORIO and UDELL. Referred
to Committee on Health.
***AUTHORS SUBJECT TO CHANGE***
AN ACT to create 609.835 and 632.895 (16g) of the statutes; relating to: cost-
sharing caps on prescription drugs and medical supplies to treat asthma
under health insurance policies and plans.
Analysis by the Legislative Reference Bureau
This bill requires health insurance policies and plans that provide coverage of
prescription drugs to cover prescription drugs and related medical supplies for the
treatment of asthma. This bill provides that Xrelated medical suppliesY includes
asthma inhalers and other medical supply items necessary to effectively and
appropriately administer a prescription drug prescribed to treat asthma. This bill
requires policies and plans to limit the amount of any enrollee cost-sharing for the
coverage provided in the bill to no more than $25 per one-month supply for each
prescription drug prescribed to treat asthma and to no more than $50 per month for
all related medical supplies. Cost-sharing may not increase with the number of
conditions for which an enrollee is treated. Further, the coverage provided in the
bill may not be subject to any deductible. However, the bill provides that the
limitations on cost-sharing and deductibles do not apply to the extent that the
limitations would result in ineligibility for a health savings account under the
federal Internal Revenue Code.
This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.
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SECTION 1
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. 609.835 of the statutes is created to read:
609.835 Coverage of prescription drugs and medical supplies to treat
asthma. Limited service health organizations, preferred provider plans, and
defined network plans are subject to s. 632.895 (16g).
SECTION 2. 632.895 (16g) of the statutes is created to read:
632.895 (16g) COVERAGE OF PRESCRIPTION DRUGS AND MEDICAL SUPPLIES TO
TREAT ASTHMA. (a) In this subsection, Xrelated medical suppliesY includes asthma
inhalers and other medical supply items necessary to effectively and appropriately
administer a prescription drug prescribed to treat asthma.
(b) Subject to par. (c), every disability insurance policy and every self-insured
health plan of the state or of a county, city, town, village, or school district that
provides coverage of prescription drugs shall cover prescription drugs and related
medical supplies for the treatment of asthma.
(c) A disability insurance policy or self-insured health plan of the state or of a
county, city, town, village, or school district to which par. (b) applies shall limit the
amount of any enrollee cost-sharing to no more than $25 per one-month supply for
each prescription drug prescribed to treat asthma and to no more than $50 per
month for all related medical supplies. The cost-sharing limitations under this
paragraph may not increase with the number of conditions for which an enrollee is
treated. Coverage under this subsection may not be subject to any deductible.
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SECTION 2
(d) If, under federal law, application of par. (c) would result in ineligibility for
a health savings account under section 223 of the Internal Revenue Code, par. (c)
shall apply to a health-savings-account-qualified high deductible health plan with
respect to the deductible of such a plan only after the enrollee has satisfied the
minimum deductible under section 223 of the Internal Revenue Code, except with
respect to items or services that are preventive care pursuant to section 223 (c) (2)
(C) of the Internal Revenue Code, in which case par. (c) shall apply regardless of
whether the minimum deductible under section 223 of the Internal Revenue Code
has been satisfied.
SECTION 3. Initial applicability.
(1) For policies and plans containing provisions inconsistent with this act, this
act first applies to policy or plan years beginning on the effective date of this
subsection, except as provided in sub. (2).
(2) For policies and plans that are affected by a collective bargaining
agreement containing provisions inconsistent with this act, this act first applies to
policy or plan years beginning on the effective date of this subsection or on the day
on which the collective bargaining agreement is newly established, extended,
modified, or renewed, whichever is later.
SECTION 4. Effective date.
(1) This act takes effect on the first day of the 4th month beginning after
publication.
(END)
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