2003 - 2004 LEGISLATURE
May 28, 2003 - Introduced by Representatives Vrakas, Ladwig, McCormick,
Gielow, Van Roy, Cullen, Shilling, Huber, Plouff, Vukmir, Kreibich,
Gronemus, Owens, Musser, Hahn, Seratti, Stone, Jeskewitz, Kerkman,
Pocan, Ott, Hines, Petrowski, Townsend, Hundertmark, Taylor, Turner,
Nischke, Morris, Pettis
and A. Williams, cosponsored by Senators Roessler,
Darling, Robson, A. Lasee, Carpenter, Brown, Hansen, Wirch
and M. Meyer.
Referred to Committee on Insurance.
AB364,1,4 1An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 111.91 (2) (n), 120.13 (2) (g),
2185.981 (4t) and 185.983 (1) (intro.); and to create 609.87 and 632.895 (15) of
3the statutes; relating to: required coverage of off-label drugs for the treatment
4of cancer.
Analysis by the Legislative Reference Bureau
This bill requires health care plans that provide coverage of prescription
medication to provide coverage of a drug, and services related to administering the
drug, that is prescribed by a licensed physician for treating cancer. In order for the
requirement to apply, however, the drug must be: 1) approved by the federal Food
and Drug Administration for use in treating at least one indication, which is defined
in the bill as the basis for initiating a diagnostic test or treatment for a disease; and
2) recognized as effective for treating the type of cancer for which it is prescribed in
the American Hospital Formulary Service Drug Information, the official United
States Pharmacopeia Drug Information, or at least one article published in a journal,
if the article meets uniform requirements for manuscripts submitted to biomedical
journals or if the journal in which the article is published is specified as accepted
peer-reviewed medical literature by the secretary of the federal Department of
Health and Human Services under an existing federal law requirement.
The coverage requirement applies to both individual and group health
insurance policies and plans, including health care plans offered by the state or a
municipality or school district. The coverage may not be subject to any limitations,
exclusions, or cost-sharing provisions that are greater than those that apply

generally under the policy or plan. The requirement does not apply to limited benefit
plans, such as vision or dental plans, or to policies that cover only certain specified
diseases other than cancer.
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:
AB364, s. 1 1Section 1. 40.51 (8) of the statutes is amended to read:
AB364,2,52 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
3shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
4and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to
5(5), 632.895 (5m) and (8) to (14) (15), and 632.896.
AB364, s. 2 6Section 2. 40.51 (8m) of the statutes is amended to read:
AB364,2,97 40.51 (8m) Every health care coverage plan offered by the group insurance
8board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
9632.748, 632.83, 632.835, 632.85, 632.853, 632.855, and 632.895 (11) to (14) (15).
AB364, s. 3 10Section 3. 66.0137 (4) of the statutes is amended to read:
AB364,2,1611 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
12a village provides health care benefits under its home rule power, or if a town
13provides health care benefits, to its officers and employees on a self-insured basis,
14the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
15632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4) and (5),
16632.895 (9) to (14) (15), 632.896 , and 767.25 (4m) (d).
AB364, s. 4 17Section 4. 111.91 (2) (n) of the statutes is amended to read:
AB364,2,1918 111.91 (2) (n) The provision to employees of the health insurance coverage
19required under s. 632.895 (11) to (14) (15).
AB364, s. 5
1Section 5. 120.13 (2) (g) of the statutes is amended to read:
AB364,3,52 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
349.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
4632.85, 632.853, 632.855, 632.87 (4) and (5), 632.895 (9) to (14) (15), 632.896, and
5767.25 (4m) (d).
AB364, s. 6 6Section 6. 185.981 (4t) of the statutes is amended to read:
AB364,3,107 185.981 (4t) A sickness care plan operated by a cooperative association is
8subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85,
9632.853, 632.855, 632.87 (2m), (3), (4), and (5), 632.895 (10) to (14) (15), and 632.897
10(10) and chs. 149 and 155.
AB364, s. 7 11Section 7. 185.983 (1) (intro.) of the statutes is amended to read:
AB364,3,1812 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be
13exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
14601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
15631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853,
16632.855, 632.87 (2m), (3), (4), and (5), 632.895 (5) and (9) to (14) (15), 632.896 , and
17632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring association
18shall:
AB364, s. 8 19Section 8. 609.87 of the statutes is created to read:
AB364,3,21 20609.87 Coverage of certain drugs for cancer treatment. Defined network
21plans are subject to s. 632.895 (15).
AB364, s. 9 22Section 9. 632.895 (15) of the statutes is created to read:
AB364,4,223 632.895 (15) Coverage of certain drugs for cancer treatment. (a) In this
24subsection, "indication" means the basis for initiation of a diagnostic test or a

1treatment for a disease, which basis may be derived from a knowledge of the cause,
2from symptoms present, or from the nature of the disease.
AB364,4,73 (b) Except as provided in par. (e), every disability insurance policy, and every
4self-insured health plan of the state or a county, city, village, town, or school district,
5that provides coverage of prescription medication shall provide coverage of a drug
6that is prescribed by a licensed physician for treating cancer if all of the following
7apply:
AB364,4,98 1. The federal food and drug administration has approved the drug for use in
9treating at least one indication.
AB364,4,1110 2. The drug is recognized as effective for treating the type of cancer for which
11it is prescribed in any of the following:
AB364,4,1212 a. The American Hospital Formulary Service Drug Information.
AB364,4,1313 b. The official United States Pharmacopeia Drug Information.
AB364,4,1914 c. At least one article that is published in a journal, if the article meets the
15uniform requirements established by the International Committee of Medical
16Journal Editors for manuscripts submitted to biomedical journals or, if the article
17does not meet those requirements, the journal in which the article is published is
18specified as accepted peer-reviewed medical literature by the federal secretary of
19health and human services under 42 USC 1395x (t) (2) (B) (ii) (II).
AB364,4,2320 (c) A disability insurance policy or a self-insured health plan that is required
21to provide the coverage under par. (b) shall also provide coverage for medically
22necessary services related to administering a drug for which coverage is required
23under par. (b).
AB364,5,224 (d) The coverage required under pars. (b) and (c) may not be subject to any
25limitations, exclusions, or cost-sharing provisions that are greater than those that

1apply generally to prescription medication or services under the disability insurance
2policy or the self-insured health plan.
AB364,5,43 (e) The coverage requirement under par. (b) does not apply to any of the
4following types of health care plans:
AB364,5,65 1. A disability insurance policy that covers only certain specified diseases other
6than cancer.
AB364,5,97 2. A health care plan offered by a limited service health organization, as defined
8in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not
9a defined network plan, as defined in s. 609.01 (1b).
AB364, s. 10 10Section 10. Initial applicability.
AB364,5,1111 (1) This act first applies to all of the following:
AB364,5,1412 (a) Except as provided in paragraphs (b) and (c ), disability insurance policies
13that are issued or renewed, and self-insured health plans that are established,
14extended, modified, or renewed, on the effective date of this paragraph.
AB364,5,1715 (b) Disability insurance policies covering employees who are affected by a
16collective bargaining agreement containing provisions inconsistent with this act
17that are issued or renewed on the earlier of the following:
AB364,5,18 181. The day on which the collective bargaining agreement expires.
AB364,5,20 192. The day on which the collective bargaining agreement is extended, modified,
20or renewed.
AB364,5,2321 (c) Self-insured health plans covering employees who are affected by a
22collective bargaining agreement containing provisions inconsistent with this act
23that are established, extended, modified, or renewed on the earlier of the following:
AB364,5,24 241. The day on which the collective bargaining agreement expires.
AB364,6,2
12. The day on which the collective bargaining agreement is extended, modified,
2or renewed.
AB364, s. 11 3Section 11. Effective date.
AB364,6,54 (1) This act takes effect on the first day of the 7th month beginning after
5publication.
AB364,6,66 (End)
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