LRB-2877/2
MDK&PJK:cmh:km
1999 - 2000 LEGISLATURE
September 14, 1999 - Introduced by Representatives Waukau, Krug, Musser,
Gronemus, Ryba, Lassa, Berceau, Pocan, Miller, Hasenohrl, Plouff and
Seratti, cosponsored by Senators Clausing, Roessler, Erpenbach and
George. Referred to Committee on Health.
AB451,1,3
1An Act to repeal 111.91 (2) (r); and
to create 111.91 (2) (r) of the statutes;
2relating to: revision of certain prescription orders and insurance coverage
3under those orders.
Analysis by the Legislative Reference Bureau
Under this bill, a patient may request a practitioner to revise a prescription
order to ensure that the quantity of the drug product or device that is prescribed is
not depleted until after January 31, 2000. Upon the request of a patient, a
practitioner must revise a prescription order if: 1) the drug product or device is
prescribed in a quantity that is likely to be depleted during the month of January,
2000; 2) the patient has a chronic condition or the drug product or device is likely to
be appropriate to treat the patient's condition at least until January 31, 2000; and
3) an interruption of the supply of the drug product or device during the month of
January, 2000, may cause substantial physical or mental discomfort or undesirable
health consequences for the patient. A patient may request only one revision of a
prescription order under the bill.
Also under the bill, if a patient has coverage under a health benefit plan or a
self-insured health plan for a drug product or device that is prescribed under a
revised prescription order, the health benefit plan or self-insured health plan may
not deny coverage for the drug product or device solely on the basis of the quantity
of the drug product or device prescribed, or the length of time for which the drug
product or device is prescribed, under the revised order. This requirement applies
to self-insured health plans of the state, municipalities and school districts, and to
all types of health benefit plans, including managed care plans.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB451, s. 1
1Section
1. 111.91 (2) (r) of the statutes is created to read:
AB451,2,32
111.91
(2) (r) The requirement under 1999 Wisconsin Act .... (this act), section
33 (3
), related to coverage of drugs or devices under revised prescription orders.
AB451, s. 2
4Section
2. 111.91 (2) (r) of the statutes, as created by 1999 Wisconsin Act ....
5(this act), is repealed.
AB451,2,77
(1)
Definitions. In this section:
AB451,2,88
(a) "Device" has the meaning given in section 450.01 (6) of the statutes.
AB451,2,119
(b) "Drug" has the meaning given in section 450.01 (10) of the statutes, but does
10not include a controlled substance included, whether by statute or rule, in schedules
11II to V of chapter 961 of the statutes.
AB451,2,1312
(c) "Drug product" means means a specific drug or drugs in a specific dosage
13form and strength from a known source of manufacture.
AB451,2,1514
(d) "Health benefit plan" has the meaning given in section 632.745 (11) of the
15statutes.
AB451,2,1616
(e) "Patient" has the meaning given in section 450.01 (14) of the statutes.
AB451,2,1717
(f) "Practitioner" has the meaning given in section 450.01 (17) of the statutes.
AB451,2,2018
(g) "Prescription order" means a prescription order, as defined in section 450.01
19(21) of the statutes, that specifies a drug product or device in a quantity that is likely
20to be depleted at any time during the month of January, 2000.
AB451,3,2
1(h) "Self-insured health plan" has the meaning given in section 632.745 (24)
2of the statutes.
AB451,3,33
(2)
Revision of certain prescription orders.
AB451,3,64
(a) Upon the request of a patient, a practitioner shall revise a prescription order
5to ensure that the quantity of the drug product or device that is prescribed is not
6depleted until after January 31, 2000, if each of the following is satisfied:
AB451,3,9
71. The patient's condition for which the prescription order is issued is chronic
8or the drug product or device that is prescribed is likely to be appropriate to treat the
9patient's condition at least until January 31, 2000.
AB451,3,12
102. An interruption during the month of January, 2000, of the supply of the drug
11product or device that is prescribed may cause substantial physical or mental
12discomfort or undesirable health consequences for the patient.
AB451,3,1413
(b) A patient may request only one revision of a prescription order under
14paragraph (a).
AB451,3,2215
(3)
Insurance coverage of revised prescription orders. If a patient for whom
16a practitioner revises a prescription order under subsection (2) is covered under a
17health benefit plan or a self-insured health plan that provides coverage of the drug
18product or device that is prescribed under the revised prescription order, the health
19benefit plan or self-insured health plan may not deny coverage of the drug product
20or device under the revised prescription order solely on the basis of the quantity of
21the drug product or device that is prescribed or the length of time for which the drug
22product or device is prescribed under the revised prescription order.
AB451,4,3
1(1)
Insurance coverage of revised prescription orders. The creation of
2section 111.91 (2) (r) of the statutes and
Section 3 (3
) of this act first apply to all of
3the following:
AB451,4,84
(a) Except as provided in paragraphs (b) and (c
), health benefit plans
5containing terms or provisions inconsistent with
Section
3 (3
) of this act that are
6renewed on the effective date of this paragraph and self-insured health plans
7containing terms or provisions inconsistent with
Section
3 (3
) of this act that are
8extended, modified or renewed on the effective date of this paragraph.
AB451,4,119
(b) Health benefit plans covering employes who are affected by a collective
10bargaining agreement containing provisions inconsistent with
Section 3 (3) of this
11act that are issued or renewed on the earlier of the following:
AB451,4,12
121. The day on which the collective bargaining agreement expires.
AB451,4,14
132. The day on which the collective bargaining agreement is extended, modified
14or renewed.
AB451,4,1815
(c) Self-insured health plans covering employes who are affected by a collective
16bargaining agreement containing provisions inconsistent with
Section 3 (3) of this
17act that are established, extended, modified or renewed on the earlier of the
18following:
AB451,4,19
191. The day on which the collective bargaining agreement expires.
AB451,4,21
202. The day on which the collective bargaining agreement is extended, modified
21or renewed.
AB451, s. 5
22Section
5.
Effective dates. This act takes effect on the day after publication,
23except as follows:
AB451,5,2
1(1)
The repeal of section 111.91 (2) (r) of the statutes takes effect on February
21, 2000.
