Wisconsin 2025-2026 Regular Session

Wisconsin Senate Bill SB251 Compare Versions

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

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1	1	2025 - 2026 LEGISLATURE
2	2	LRB-2917/1
3	3	JPC:cjs&skw
4	4	2025 SENATE BILL 251
5	5	May 9, 2025 - Introduced by Senators DASSLER-ALFHEIM, KEYESKI, DRAKE,
6	6	HESSELBEIN, L. JOHNSON, LARSON, RATCLIFF, ROYS, SPREITZER and WIRCH,
7	7	cosponsored by Representatives SNODGRASS, MAYADEV, MCCARVILLE,
8	8	ANDERSON, ANDRACA, ARNEY, BARE, BROWN, CLANCY, DESMIDT, EMERSON,
9	9	FITZGERALD, J. JACOBSON, JOERS, JOHNSON, MADISON, MIRESSE, MOORE
10	10	OMOKUNDE, NEUBAUER, ORTIZ-VELEZ, PALMERI, PHELPS, PRADO, ROE,
11	11	SHEEHAN, SPAUDE, STROUD, STUBBS, SUBECK, TENORIO and UDELL. Referred
12	12	to Committee on Health.
13	13
14	14	*AUTHORS SUBJECT TO CHANGE*
15	15	AN ACT to create 609.835 and 632.895 (16g) of the statutes; relating to: cost-
16	16	sharing caps on prescription drugs and medical supplies to treat asthma
17	17	under health insurance policies and plans.
18	18	Analysis by the Legislative Reference Bureau
19	19	This bill requires health insurance policies and plans that provide coverage of
20	20	prescription drugs to cover prescription drugs and related medical supplies for the
21	21	treatment of asthma. This bill provides that Xrelated medical suppliesY includes
22	22	asthma inhalers and other medical supply items necessary to effectively and
23	23	appropriately administer a prescription drug prescribed to treat asthma. This bill
24	24	requires policies and plans to limit the amount of any enrollee cost-sharing for the
25	25	coverage provided in the bill to no more than $25 per one-month supply for each
26	26	prescription drug prescribed to treat asthma and to no more than $50 per month for
27	27	all related medical supplies. Cost-sharing may not increase with the number of
28	28	conditions for which an enrollee is treated. Further, the coverage provided in the
29	29	bill may not be subject to any deductible. However, the bill provides that the
30	30	limitations on cost-sharing and deductibles do not apply to the extent that the
31	31	limitations would result in ineligibility for a health savings account under the
32	32	federal Internal Revenue Code.
33	33	This proposal may contain a health insurance mandate requiring a social and
34	34	financial impact report under s. 601.423, stats.
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37	37	3 2025 - 2026 Legislature
38	38	SENATE BILL 251
39	39	- 2 - LRB-2917/1
40	40	JPC:cjs&skw
41	41	SECTION 1
42	42	For further information see the state fiscal estimate, which will be printed as
43	43	an appendix to this bill.
44	44	The people of the state of Wisconsin, represented in senate and assembly, do
45	45	enact as follows:
46	46	SECTION 1. 609.835 of the statutes is created to read:
47	47	609.835 Coverage of prescription drugs and medical supplies to treat
48	48	asthma. Limited service health organizations, preferred provider plans, and
49	49	defined network plans are subject to s. 632.895 (16g).
50	50	SECTION 2. 632.895 (16g) of the statutes is created to read:
51	51	632.895 (16g) COVERAGE OF PRESCRIPTION DRUGS AND MEDICAL SUPPLIES TO
52	52	TREAT ASTHMA. (a) In this subsection, Xrelated medical suppliesY includes asthma
53	53	inhalers and other medical supply items necessary to effectively and appropriately
54	54	administer a prescription drug prescribed to treat asthma.
55	55	(b) Subject to par. (c), every disability insurance policy and every self-insured
56	56	health plan of the state or of a county, city, town, village, or school district that
57	57	provides coverage of prescription drugs shall cover prescription drugs and related
58	58	medical supplies for the treatment of asthma.
59	59	(c) A disability insurance policy or self-insured health plan of the state or of a
60	60	county, city, town, village, or school district to which par. (b) applies shall limit the
61	61	amount of any enrollee cost-sharing to no more than $25 per one-month supply for
62	62	each prescription drug prescribed to treat asthma and to no more than $50 per
63	63	month for all related medical supplies. The cost-sharing limitations under this
64	64	paragraph may not increase with the number of conditions for which an enrollee is
65	65	treated. Coverage under this subsection may not be subject to any deductible.
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85	85	20 2025 - 2026 Legislature
86	86	SENATE BILL 251
87	87	- 3 - LRB-2917/1
88	88	JPC:cjs&skw
89	89	SECTION 2
90	90	(d) If, under federal law, application of par. (c) would result in ineligibility for
91	91	a health savings account under section 223 of the Internal Revenue Code, par. (c)
92	92	shall apply to a health-savings-account-qualified high deductible health plan with
93	93	respect to the deductible of such a plan only after the enrollee has satisfied the
94	94	minimum deductible under section 223 of the Internal Revenue Code, except with
95	95	respect to items or services that are preventive care pursuant to section 223 (c) (2)
96	96	(C) of the Internal Revenue Code, in which case par. (c) shall apply regardless of
97	97	whether the minimum deductible under section 223 of the Internal Revenue Code
98	98	has been satisfied.
99	99	SECTION 3. Initial applicability.
100	100	(1) For policies and plans containing provisions inconsistent with this act, this
101	101	act first applies to policy or plan years beginning on the effective date of this
102	102	subsection, except as provided in sub. (2).
103	103	(2) For policies and plans that are affected by a collective bargaining
104	104	agreement containing provisions inconsistent with this act, this act first applies to
105	105	policy or plan years beginning on the effective date of this subsection or on the day
106	106	on which the collective bargaining agreement is newly established, extended,
107	107	modified, or renewed, whichever is later.
108	108	SECTION 4. Effective date.
109	109	(1) This act takes effect on the first day of the 4th month beginning after
110	110	publication.
111	111	(END)
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