AB355,12,12 7(2) (a) By January 1, 2004, the committee shall determine the relative clinical
8efficacy and safety of the prescription drugs within each therapeutic class. The
9committee shall conduct an evidence-based analysis to determine the relative
10clinical efficacy and safety, including a review of relevant literature. The committee
11shall periodically review and amend its determinations of relative clinical efficacy
12and safety.
AB355,12,1613 (b) Notwithstanding par. (a), the committee may adopt determinations of
14relative clinical efficacy and safety made by a similar governmental entity in another
15state, if the other entity uses standards for determining clinical efficacy and safety
16that are similar to the standards adopted by the committee.
AB355,12,2117 (c) The committee shall make a determination regarding the relative clinical
18efficacy and safety of a new single-source prescription drug within 60 days after it
19is approved by the federal food and drug administration or, if the committee does not
20receive sufficient information to make a determination within 60 days after
21approval, within 60 days after receiving such information.
AB355,13,4 22(3) (a) The department shall solicit bids or proposals from manufacturers and
23labelers to provide rebates on prescription drugs that are purchased under
24state-supported health care assistance programs. Any rebate offered by a
25manufacturer or labeler in response to a solicitation under this paragraph shall be

1in addition to any rebate that the manufacturer or labeler provides under 42 USC
21396r-8
and in addition to any rebate required under state law or provided under
3an agreement between the state and a manufacturer or labeler that is in effect on the
4effective date of the solicitation.
AB355,13,95 (b) Subject to sub. (8), the department shall solicit bids or proposals from
6manufacturers and labelers to provide rebates on prescription drugs that are
7purchased under the Prescription Drug Assistance Program, under health care
8coverage plans for government employees, or under private health care coverage
9plans.
AB355,13,1110 (c) The department may join with similar governmental entities in other states
11to solicit rebates under this subsection.
AB355,13,13 12(4) (a) Using the method prescribed under par. (b) the department shall create
13the following 2 preferred drug lists:
AB355,13,1414 1. One preferred drug list for state-supported health care assistance programs.
AB355,13,1715 2. A 2nd preferred drug list for the Prescription Drug Assistance Program,
16health care coverage plans for government employees, and private health care
17coverage plans.
AB355,13,2418 (b) The department shall consider the relative clinical efficacy and safety and
19the cost of each prescription drug in a therapeutic class, and place the most
20cost-effective prescription drug or drugs in the class on a preferred drug list. In
21determining cost under this paragraph, the department shall consider any rebate
22offered under sub. (3) (a) or (b), whichever is applicable, any existing rebate
23agreement or requirement, dosing practices, and any other relevant cost
24information.
AB355,14,8
1(c) Notwithstanding par. (b), the department shall include all prescription
2drugs that the committee determines are clinically effective and safe for treating
3acquired immunodeficiency syndrome or the human immunodeficiency virus on both
4preferred drug lists created under this subsection. The department shall also
5include all prescription drugs that bear generic names on the preferred drug lists
6unless the prescription drugs that bear generic names are unreasonably priced
7compared to other prescription drugs within a therapeutic class that are selected for
8a preferred drug list.
AB355,14,13 9(5) By July 1, 2004, the department shall enter into agreements with the
10manufacturers or labelers of the prescription drugs on the preferred drug list under
11sub. (4) (a) 1. to pay the state the rebates proposed under sub. (3) (a) on prescription
12drugs that are purchased under state-supported health care assistance programs on
13or after July 1, 2004.
AB355,14,17 14(6) (a) Subject to sub. (8), the department shall enter into agreements with the
15manufacturers or labelers of prescription drugs on the preferred drug list under sub.
16(4) (a) 2. to pay the rebates proposed under sub. (3) (b) on prescription drugs that are
17purchased under the following programs or plans:
AB355,14,1818 1. The Prescription Drug Assistance Program.
AB355,14,2019 2. Health care coverage plans offered by the state to state employees who are
20not subject to collective bargaining.
AB355,14,2421 3. Health care coverage plans offered by the state to state employees who are
22subject to collective bargaining, if the employees agree through collective bargaining
23to subject their health care coverage to policies that encourage use of the preferred
24drug list under sub. (4) (a) 2.
AB355,15,4
14. Health care coverage plans offered by a local governmental unit to employees
2of the local governmental unit who are subject to collective bargaining, if the
3employees agree through collective bargaining to subject their health care coverage
4to policies that encourage use of the preferred drug list under sub. (4) (a) 2.
AB355,15,85 5. Health care coverage plans offered by a local governmental unit to its
6employees who are not subject to collective bargaining or private health care
7coverage plans, if the department approves the plan, or the employment contract
8that provides for the plan under par. (b).
AB355,15,149 (b) An entity that purchases or negotiates health insurance coverage for
10employees of a local governmental unit or that purchases or negotiates a private
11health care coverage plan may apply to the department to approve a health care
12coverage plan, or an employment contract that provides for health care coverage.
13The department shall approve the plan or contract if it includes policies to encourage
14use of the preferred drug list under sub. (4) (a) 2.
AB355,15,1615 (c) For purposes of this section, all of the following constitute policies to
16encourage use of the preferred drug list under sub. (4) (a) 2.:
AB355,15,1717 1. Prior authorization for off-list prescription drugs.
AB355,15,1918 2. Higher copayments for off-list prescription drugs than for drugs that are on
19the preferred drug list.
AB355,15,2120 3. Education for practitioners who prescribe off-list prescription drugs without
21medical justification.
AB355,16,222 (d) The department shall charge entities that receive rebates under par. (a) 4.
23or 5. a fee to support the administrative costs of creating and maintaining the
24preferred drug lists under sub. (4). The department shall promulgate rules
25establishing the method for determining the amount of the fee. All fees collected

1under this paragraph shall be credited to the appropriation account under s. 20.435
2(4) (jt).
AB355,16,53 (e) Manufacturers and labelers shall pay rebates under par. (a) 1., 2., and 3.,
4to the state, and shall pay rebates under par. (a) 4. and 5. to the entity designated
5by the department.
AB355,16,12 6(7) All rebates paid to the state under subs. (5) and (6) (a) 1., 2., and 3. shall
7be credited to the appropriation account under s. 20.435 (4) (jx). The department
8shall calculate the amount of rebates earned on prescription drugs purchased under
9each of the state-supported health care assistance programs, under the Prescription
10Drug Assistance Program, and under health care coverage plans for state employees,
11and shall allocate the amount earned under each program or plan for that program
12or plan.
AB355,16,15 13(8) The department shall determine when to cover each of the programs or
14plans under sub. (6) (a) 1., 2., 3., 4., and 5. in solicitations under sub. (3) (b) and in
15agreements under sub. (6) (a).
AB355,16,18 16(9) (a) By July 1, 2004, the department shall implement at least one of the
17following prescription drug cost containment measures using the preferred drug list
18created under sub. (4) (a) 1.:
AB355,17,519 1. The department may require practitioners to obtain prior authorization from
20the department or its fiscal agent for any off-list prescription drug purchased under
21a state-supported health care assistance program and may prohibit reimbursement
22of pharmacists, pharmacies, or any other provider for any off-list prescription drug
23purchased under a state-supported health care assistance program for which prior
24authorization is not obtained. If the department requires prior authorization under
25this subdivision, and a practitioner requests prior authorization for an off-list

1prescription drug, the department or its fiscal agent shall respond to the request by
2telephone or other telecommunication means within 24 hours after the request is
3received. In an emergency situation, the department shall reimburse a pharmacy
4or pharmacist for at least a 7-day supply of a prescription without prior
5authorization.
AB355,17,116 2. The department may monitor the purchase of prescription drugs under
7state-supported health care assistance programs to identify practitioners who
8routinely prescribe off-list prescription drugs without medical justification and
9request that the medical examining board, board of nursing, or dentistry examining
10board, whichever is applicable, investigate and, if appropriate, require education for
11such practitioners under s. 441.16 (7), 447.08, or 448.075, whichever is applicable.
AB355,17,1712 (b) The department may monitor the purchase of prescription drugs under the
13Prescription Drug Assistance Program to identify practitioners who routinely
14prescribe off-list prescription drugs without medical justification and request that
15the medical examining board, board of nursing, or dentistry examining board,
16whichever is applicable, investigate and, if appropriate, require education for such
17practitioners under s. 441.16 (7), 447.08, or 448.075, whichever is applicable.
AB355,17,20 18(10) (a) The department may enter into a contract with an entity to perform
19the duties and exercise the powers of the department, other than promulgation of
20rules, under subs. (3), (4), (5), and (6).
AB355,17,2521 (b) The department may not contract under this subsection with an entity if the
22entity, its parent company, or its subsidiary has any direct or indirect financial
23interest in sales of a particular prescription drug. The department shall require an
24entity to disclose all such financial interests before the department contracts with
25the entity under this subsection.
AB355,18,3
1(c) An entity that enters into a contract with the department under this
2subsection, or a parent company or subsidiary of that entity, may not incur a financial
3interest in sales of a particular prescription drug during the term of the contract.
AB355,18,64 (d) The department shall periodically audit any entity with which it contracts
5under this subsection to determine whether the entity, its parent company, or a
6subsidiary has any financial interests that are prohibited under this subsection.
AB355, s. 14 7Section 14. 49.692 of the statutes is created to read:
AB355,18,8 849.692 Prescription drug assistance. (1) In this section:
AB355,18,99 (a) "Labeler" has the meaning given in s. 49.69 (1) (d).
AB355,18,1010 (b) "Manufacturer" has the meaning given in s. 49.69 (1) (f).
AB355,18,1411 (c) "Participating pharmacy or pharmacist" means a person who is licensed as
12a pharmacy or pharmacist in any state and who agrees to sell prescription drugs to
13a person who has a prescription drug card issued under sub. (3) for the amount
14provided under sub. (5).
AB355,18,1515 (d) "Prescription drug" has the meaning given in s. 450.01 (20).
AB355,18,1616 (e) "Prescription order" has the meaning given in s. 450.01 (21).
AB355,18,1717 (f) "State" has the meaning given in s. 441.50 (2) (m).
AB355,18,20 18(2) (a) A person to whom all of the following applies is eligible to purchase
19prescription drugs from a participating pharmacy or pharmacist for the amount
20provided under sub. (5):
AB355,18,2121 1. The person is a resident, as defined in s. 27.01 (10) (a), of this state.
AB355,19,222 2. The person is not a recipient of Medical Assistance, does not have health care
23coverage under s. 49.665, does not have a policy issued under ch. 149, is not enrolled
24in the program under s. 49.688, and does not have insurance coverage for
25prescription drugs for outpatient care, except that a person who receives benefits

1under 42 USC 1395 to 1395ccc may have supplemental health insurance that covers
2prescription drugs for outpatient care.
AB355,19,53 (b) A person may apply to the department, on a form provided by the
4department, for a determination of eligibility and issuance of a prescription drug
5card for purchase of prescription drugs under this section.
AB355,19,10 6(3) The department shall devise and distribute a form for applying for the
7program under sub. (2), shall determine eligibility for each 12-month benefit period
8of applicants, and, after payment by the applicant of a program enrollment fee for
9each 12-month benefit period, shall issue to eligible persons a prescription drug card
10for use in purchasing prescription drugs, as provided under this section.
AB355,19,12 11(4) The department shall set maximum prices and a maximum dispensing fee
12for prescription drugs purchased under this section.
AB355,19,18 13(5) Beginning September 1, 2004, a participating pharmacy or pharmacist may
14not charge a person who presents a valid prescription order and a prescription drug
15card issued under sub. (3) more than the maximum price established by the
16department under sub. (4) for a prescription drug, less any rebate amount agreed to
17under s. 49.69 (6) (a) 1., plus the maximum dispensing fee established by the
18department under sub. (4).
AB355,19,23 19(6) From the appropriation account under s. 20.435 (4) (jx) and (8) (mb), the
20department shall reimburse participating pharmacies and pharmacists the
21applicable rebate amounts specified in agreements under s. 49.69 (6) (a) 1., if any, for
22each prescription drug that the pharmacy or pharmacist sells to a person who has
23a prescription drug card issued under sub. (3).
AB355,19,24 24(7) The department shall promulgate rules establishing the following:
AB355,20,2
1(a) The method for determining the maximum retail price for a prescription
2drug.
AB355,20,33 (b) The method for determining the maximum dispensing fee.
AB355,20,54 (c) The method for informing participating pharmacies and pharmacists of the
5maximum prices, dispensing fees, and rebate amounts for prescription drugs.
AB355,20,76 (d) The process by which a participating pharmacy or pharmacist may claim
7reimbursement for rebates.
AB355,20,108 (e) The process for resolving discrepancies between the rebate amount claimed
9by a participating pharmacy or pharmacist and the amount paid by a manufacturer
10or labeler.
AB355, s. 15 11Section 15 . 49.692 (6) of the statutes, as created by 2003 Wisconsin Act .... (this
12act), is amended to read:
AB355,20,1713 49.692 (6) From the appropriation account under s. 20.435 (4) (jx) and (8) (mb),
14the department shall reimburse participating pharmacies and pharmacists the
15applicable rebate amounts specified in agreements under s. 49.69 (6) (a) 1., if any, for
16each prescription drug that the pharmacy or pharmacist sells to a person who has
17a prescription drug card issued under sub. (3).
AB355, s. 16 18Section 16. 146.93 (1) (a) of the statutes is amended to read:
AB355,20,2319 146.93 (1) (a) From the appropriation appropriation accounts under s. 20.435
20(4) (gp) and (jx), the department shall maintain a program for the provision of
21primary health care services based on the primary health care program in existence
22on June 30, 1987. The department may promulgate rules necessary to implement
23the program.
AB355, s. 17 24Section 17. 149.14 (4c) (c) of the statutes is created to read:
AB355,21,7
1149.14 (4c) (c) The department or an entity with which the department
2contracts shall provide to a drug manufacturer that sells drugs for prescribed use in
3this state documents designed for use by the manufacturer in entering into a rebate
4agreement with the department or entity that is modeled on the rebate agreement
5specified under 42 USC 1396r-8. The department or entity may enter into a rebate
6agreement under this paragraph that shall include all of the following as
7requirements:
AB355,21,148 1. That, as a condition of coverage for prescription drugs of a manufacturer
9under this section other than prescription drugs that are prescribed for the
10treatment of acquired immunodeficiency syndrome or human immunodeficiency
11virus, the manufacturer shall make rebate payments for each prescription drug of
12the manufacturer, that is prescribed for and purchased by an eligible person, to the
13state treasurer to be credited to the appropriation account under s. 20.435 (4) (jh),
14each calendar quarter or according to a schedule established by the department.
AB355,21,1615 2. That the amount of the rebate payment shall be determined by a method
16specified in 42 USC 1396r-8 (c).
AB355, s. 18 17Section 18. 149.143 (1) (a) of the statutes is amended to read:
AB355,21,2018 149.143 (1) (a) First from the moneys transferred to the fund from the
19appropriation account under s. 20.435 (4) (af) and from the moneys appropriated for
20the health insurance risk-sharing plan under s. 20.435 (4) (jh) and (jx)
.
AB355, s. 19 21Section 19. 441.16 (7) of the statutes is created to read:
AB355,22,722 441.16 (7) Upon the request of the department of health and family services,
23the board shall investigate an advanced practice nurse to determine whether the
24advanced practice nurse routinely prescribes prescription drugs that are not on the
25applicable preferred drug list established under s. 49.69 to beneficiaries of

1state-supported health care assistance programs, as defined in s. 49.69 (1) (m), or
2to persons enrolled in the prescription drug assistance program under s. 49.692,
3without medical justification. If the board determines that an advanced practice
4nurse routinely prescribes drugs that are not on the applicable preferred drug list
5without medical justification, the board shall require the advanced practice nurse to
6complete the preferred drug list education program under s. 448.075 (2) at the
7earliest possible opportunity.
AB355, s. 20 8Section 20. 447.08 of the statutes is created to read:
AB355,22,18 9447.08 Preferred drug list compliance. Upon the request of the
10department of health and family services, the board shall investigate a dentist to
11determine whether the dentist routinely prescribes prescription drugs that are not
12on the applicable preferred drug list established under s. 49.69 to beneficiaries of
13state-supported health care assistance programs, as defined in s. 49.69 (1) (m), or
14to persons enrolled in the Prescription Drug Assistance Program under s. 49.692,
15without medical justification. If the board determines that a dentist routinely
16prescribes drugs that are not on the applicable preferred drug list without medical
17justification, the board shall require the dentist to complete the preferred drug list
18education program under s. 448.075 (2) at the earliest possible opportunity.
AB355, s. 21 19Section 21. 448.075 of the statutes is created to read:
AB355,23,620 448.075 Preferred drug list compliance. (1) Upon the request of the
21department of health and family services, the board shall investigate a physician or
22physician assistant to determine whether the physician or physician assistant
23routinely prescribes prescription drugs that are not on the applicable preferred drug
24list established under s. 49.69 to beneficiaries of state-supported health care
25assistance programs, as defined in s. 49.69 (1) (m), or to persons enrolled in the

1Prescription Drug Assistance Program under s. 49.692, without medical
2justification. If the board determines that a physician or physician assistant
3routinely prescribes drugs that are not on the applicable preferred drug list without
4medical justification, the board shall require the physician or physician assistant to
5complete the preferred drug list education program under sub. (2) at the earliest
6possible opportunity.
AB355,23,16 7(2) The department of regulation and licensing shall develop an education
8program on the preferred drug lists created under s. 49.69 for practitioners, as
9defined in s. 450.01 (17). The department of regulation and licensing shall consult
10with the department of health and family services in developing the education
11program and shall present the education program both as a class and in visits to
12practitioners' offices. The department of regulation and licensing shall charge
13practitioners who are required under sub. (1) or s. 441.16 (7) or 447.08 to participate
14in the education program to pay a fee to cover the cost of the class or office visit. All
15fees collected under this subsection shall be credited to the appropriation account
16under s. 20.435 (4) (jt).
AB355, s. 22 17Section 22. 450.02 (2) of the statutes is renumbered 450.02 (2) (intro.) and
18amended to read:
AB355,23,2019 450.02 (2) (intro.) The board shall adopt rules defining promulgate all of the
20following rules, which apply to all applicants for licensure under s. 450.05:
AB355,23,22 21(a) Defining the active practice of pharmacy. The rules shall apply to all
22applicants for licensure under s. 450.05.
AB355, s. 23 23Section 23. 450.02 (2) (b) of the statutes is created to read:
AB355,24,224 450.02 (2) (b) Requiring disclosure by a pharmacist to a prescription drug
25purchaser who has a card issued under s. 49.692 (3) of the amount of the discount

1on the retail price of the prescription drug that is provided to the purchaser as a
2result of the program under s. 49.692.
AB355, s. 24 3Section 24. 450.075 of the statutes is created to read:
AB355,24,4 4450.075 Manufacturer gift reporting. (1) In this section:
AB355,24,55 (a) "Health benefit plan" has the meaning given in s. 632.745 (11).
AB355,24,66 (b) "Hospital" means a facility approved as a hospital under s. 50.35.
AB355,24,77 (c) "Nursing home" has the meaning given in s. 50.01 (3).
AB355,24,12 8(2) (a) Except as provided in par. (c), each person who engages in
9manufacturing shall annually report to the board the value, nature, and purpose of
10any gift, payment, subsidy, or other economic benefit valued at $25 or more that the
11person directly or indirectly provides to any of the following in connection with the
12person's promotional or marketing activities:
AB355,24,1313 1. A practitioner.
AB355,24,1414 2. A pharmacist or an owner or operator of a pharmacy.
AB355,24,1715 3. A hospital, nursing home, or organization that offers a health benefit plan,
16or an employee of a hospital, nursing home, or organization that offers a health
17benefit plan.
AB355,24,1918 4. Any other person authorized to purchase prescription drugs for retail or
19wholesale resale.
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