1999 - 2000 LEGISLATURE
February 1, 2000 - Introduced by Representatives Krusick, Balow, Berceau,
Black, Bock, Boyle, Carpenter, Coggs, Colon, Goetsch, Gronemus,
Gunderson, Hahn, Hasenohrl, Hebl, Hoven, Huber, Hubler, Hundertmark,
Jeskewitz, Kaufert, Kelso, Kestell, Klusman, Kreuser, La Fave, F. Lasee,
Lassa, J. Lehman, M. Lehman, Meyer, Meyerhofer, Miller, Morris-Tatum,
Musser, Olsen, Ott, Pettis, Plale, Plouff, Pocan, Reynolds, Richards, Riley,
Ryba, Schneider, Schooff, Sherman, Sinicki, Spillner, Staskunas,
Steinbrink, Travis, Turner, Underheim, Wasserman, Waukau, Williams and
Young, cosponsored by Senators Burke, Panzer, Robson, Shibilski, Baumgart,
Breske, Darling, Drzewiecki, Erpenbach, Farrow, George, Grobschmidt, A.
Lasee, Moore, Plache, Risser, Roessler, Rosenzweig, Wirch and Zien, by
request of Coalition of Wisconsin Aging Groups, AARP, State Board on Aging
and Long Term Care, Community Care Organization of Milwaukee, Dane
County Commission on Aging, Franklin Senior Citizens, Medical College of
Wisconsin, Medical Society of Milwaukee County, Milwaukee Police
Association, Oil Gear Retirees Club, Older Women's League Milwaukee
Chapter, Southeastern Wisconsin Area Agency on Aging, UAW Local 249
Retiree Chapter, Veterans of Foreign Wars Auxilary Cudahy, Wisconsin
Alzheimer's Association, Wisconsin Association of Aging Unit Directors,
Wisconsin Council of Senior Citizens, Wisconsin Homecare Organization and
Wisconsin Retired Educators Association. Referred to Committee on Health.
1An Act to create
20.435 (4) (bv), 20.435 (4) (j) and 49.688 of the statutes; 2relating to: prescription drug assistance for elderly persons and making
Analysis by the Legislative Reference Bureau
This bill creates a program for prescription drug assistance for elderly persons
in the department of health and family services (DHFS) and appropriates $7,000,000
in general purpose revenues in fiscal year 2000-01 for the program. Under the
program, beginning April 1, 2001, persons who are aged at least 65 years, who have
been residents of this state for at least six months, who are ineligible for medical
assistance and whose gross incomes are not more than 150% of the federal poverty
line may apply for assistance of up to $1,200 per year in paying for prescription drugs.
Prescription drugs for which a program participant may receive coverage are those
prescription drugs that are covered under the medical assistance program.
Participants in the prescription drug assistance program must pay an annual
enrollment fee of $25 and copayments of $4 for each generic prescription drug and
$8 for each brand-name drug. Under the program, DHFS is the payer of last resort
for coverage for prescription drugs and must reimburse pharmacist providers at the
rate under which pharmacists are reimbursed under the medical assistance
program. DHFS must also maintain or contract for the maintenance of a toll-free
telephone number to provide information, including application information, about
the prescription drug assistance program. In addition, if prescription drug
assistance for the number of eligible applicants exceeds the amounts of general
purpose revenues appropriated under the bill for the program and the program
revenue resulting from the annual enrollment fees and copayments, DHFS is
authorized to create waiting lists of eligible applicants. In order for drugs
manufactured by a manufacturer doing business in this state to be included in the
program, the manufacturer must enter with DHFS into a rebate agreement that is
modeled on rebate agreements under federal medicaid law. The rebate agreement
must provide that the manufacturer make payments to DHFS each calendar quarter
or as scheduled by DHFS and that the rebate payment amounts be determined by
the method specified in federal medicaid law. Beginning in 2002, DHFS must
annually, after consulting with pharmacists and advocates for elderly persons,
submit to the legislature a report on the previous year's operation of the program and
include in the report any recommendations for program changes. The bill
appropriates $1,000,000 in general purpose revenues in each of fiscal years
1999-2000 and 2000-01 to the general program supplementation appropriation
account of the joint committee on finance (JCF) and requires DHFS to submit to JCF
a plan for expenditure of these funds for administration of the prescription drug
assistance program. If the cochairpersons of JCF do not notify the secretary of health
and family services of the committee's intent to schedule a meeting to review the
plan, JCF must supplement the DHFS general program operations appropriation
account as provided in the DHFS plan. If the cochairpersons of JCF notify the
secretary of health and family services that JCF intends to schedule a meeting to
review the plan, the DHFS appropriation account may be supplemented only as
approved by JCF.
For further information see the state and local 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:
AB705, s. 1
20.005 (3) (schedule) of the statutes: at the appropriate place, insert 2
the following amounts for the purposes indicated:
- See PDF for table
AB705, s. 2
20.435 (4) (bv) of the statutes is created to read:
(bv) Prescription drug assistance for elderly; aids.
The amounts in 3
the schedule for the program for prescription drug assistance for elderly persons 4
under s. 49.688.
AB705, s. 3
20.435 (4) (j) of the statutes is created to read:
(j) Prescription drug assistance for elderly; fees and manufacturer
All moneys received from payments of enrollment fees and rebate payments 8
by manufacturers under s. 49.688 (5), to be used for prescription drug assistance for 9
elderly persons under s. 49.688.
AB705, s. 4
49.688 of the statutes is created to read:
1149.688 Prescription drug assistance for elderly persons. (1)
In this 12
(a) "Brand name" has the meaning given in s. 450.12 (1) (a).
(b) "Generic name" has the meaning given in s. 450.12 (1) (b).
(c) "Poverty line" means the nonfarm federal poverty line for the continental 16
United States, as defined by the federal department of labor under 42 USC 9902
From the appropriations under s. 20.435 (4) (bv) and (j), beginning April 1, 2
2001, the department shall reimburse pharmacists for the provision of up to $1,200 3
of prescription drugs that correspond to those prescription drugs for which 4
reimbursement is made under s. 49.46 (2) (b) 6. h. and for which the manufacturer 5
has entered into a rebate agreement with the department under sub. (5), to persons 6
who meet criteria for eligibility under sub. (3). The department is the payer of last 7
resort for coverage for prescription drugs under this subsection. The payment rate 8
for provider reimbursement shall be the allowable charges under s. 49.46 (2) (b) 6. 9
h. for prescription drugs. The department shall maintain, or contract for the 10
maintenance of, a toll-free telephone number at department headquarters to 11
provide information about the program under this subsection, including information 12
about application procedures.
(a) An individual is eligible for participation in the program under sub. (2) 14
if all of the following eligibility requirements are met:
1. The individual is at least 65 years of age, has been a resident of this state 16
for at least 6 months and is ineligible for medical assistance under s. 49.46, 49.465, 17
49.468 or 49.47.
2. The individual's gross income does not exceed 150% of the poverty line.
(b) Program participants shall pay all of the following:
1. Annually, a program enrollment fee of $25.
2. A copayment of $4 for each prescription drug provided under the program 22
that bears only a generic name.
3. A copayment of $8 for each prescription drug provided under the program 24
that bears a brand name.
If prescription drug assistance for the number of applying eligible 2
individuals under sub. (3) exceeds the amount appropriated under s. 20.435 (4) (bv) 3
and the amount available under s. 20.435 (4) (j), the department may place an 4
eligible applicant's name on a waiting list for the reimbursement program under sub. 5
A drug manufacturer that sells drugs for prescribed use in this state shall, 7
as a condition of inclusion of those drugs in the program under this section, enter 8
with the department into a rebate agreement that is modeled on the rebate 9
agreement specified under 42 USC 1396r-8
. The rebate agreement shall include all 10
of the following as requirements:
(a) That the manufacturer shall make rebate payments to the department each 12
calendar quarter or according to a schedule established by the department.
(b) That the amount of the rebate payment shall be determined by the method 14
specified in 42 USC 1396r-8
Beginning in 2002, the department shall annually, after consulting with 16
pharmacists and advocates for persons aged 65 or older, submit a report to the chief 17
clerk of each house of the legislature for distribution to the legislature under s. 18
13.172 (2). The report shall be on the operation of the program under this section for 19
the previous year and shall contain any recommendations for changes in the 20
(1) Prescription drug assistance for elderly persons; administration
. The 23
department of health and family services may request the joint committee on finance 24
to supplement, from the appropriation account under section 20.865 (4) (a) of the 25
statutes, the appropriation account under section 20.435 (4) (a) of the statutes, to pay
the costs of administration of the program of prescription drug assistance for elderly 2
persons under section 49.688 of the statutes, as created by this act. If the department 3
of health and family services requests supplementation of the appropriation account 4
under section 20.435 (4) (a) of the statutes, the department shall submit a plan to the 5
joint committee on finance to expend not more than $1,000,000 for fiscal year 6
1999-2000 and not more than $1,000,000 for fiscal year 2000-01. If the 7
cochairpersons of the committee do not notify the secretary of the department within 8
14 working days after the date of the department's submittal that the committee 9
intends to schedule a meeting to review the request, the appropriation account shall 10
be supplemented as provided in the request. If, within 14 working days after the date 11
of the department's submittal, the cochairpersons of the committee notify the 12
secretary of the department that the committee intends to schedule a meeting to 13
review the request, the appropriation account shall be supplemented only as 14
approved by the committee. Notwithstanding section 13.101 (3) (a) 1. of the statutes, 15
the committee is not required to find that an emergency exists.
AB705, s. 6
Appropriation changes; joint committee on finance.
(1) Prescription drug assistance for elderly; administration.
In the schedule 18
under section 20.005 (3) of the statutes for the appropriation to the joint committee 19
on finance under section 20.865 (4) (a) of the statutes, as affected by the acts of 1999, 20
the dollar amount is increased by $1,000,000 for fiscal year 1999-00 and the dollar 21
amount is increased by $1,000,000 for fiscal year 2000-01 to increase funding for 22
administration of the prescription drug assistance for elderly program under section 23
49.688 of the statutes, as created by this act.