LRB-5932/1
TJD:skw
2019 - 2020 LEGISLATURE
March 26, 2020 - Introduced by Senator Jacque, cosponsored by Representatives
Schraa and Wichgers. Referred to Committee on Health and Human
Services.
SB907,1,3 1An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1)
2(intro.) and 609.83; and to create 632.862 of the statutes; relating to:
3application of prescription drug payments for health coverage.
Analysis by the Legislative Reference Bureau
This bill requires health insurance policies that offer prescription drug
benefits, self-insured health plans, and pharmacy benefit managers acting on behalf
of policies or plans to apply amounts paid for prescription drugs by or on behalf of a
person covered under the policy or plan to any calculation of an out-of-pocket
maximum or to any cost-sharing requirement of the policy or plan. Health insurance
policies are referred to in the bill as disability insurance policies.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB907,1 4Section 1 . 40.51 (8) of the statutes is amended to read:
SB907,2,25 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
6shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
7and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855,

1632.862, 632.867, 632.87 (3) to (6), 632.885, 632.89, 632.895 (5m) and (8) to (17), and
2632.896.
SB907,2 3Section 2 . 40.51 (8m) of the statutes is amended to read:
SB907,2,74 40.51 (8m) Every health care coverage plan offered by the group insurance
5board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
6632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.862, 632.867,
7632.885, 632.89, and 632.895 (11) to (17).
SB907,3 8Section 3 . 66.0137 (4) of the statutes is amended to read:
SB907,2,159 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
10a village provides health care benefits under its home rule power, or if a town
11provides health care benefits, to its officers and employees on a self-insured basis,
12the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
13632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.862,
14632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513
15(4).
SB907,4 16Section 4 . 120.13 (2) (g) of the statutes is amended to read:
SB907,2,2017 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
1849.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
19632.798, 632.85, 632.853, 632.855, 632.862, 632.867, 632.87 (4) to (6), 632.885,
20632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).
SB907,5 21Section 5 . 185.983 (1) (intro.) of the statutes is amended to read:
SB907,3,422 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
23cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
24646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
25601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,

1631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85,
2632.853, 632.855, 632.862, 632.867, 632.87 (2) to (6), 632.885, 632.89, 632.895 (5) and
3(8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645, and 646, but
4the sponsoring association shall:
SB907,6 5Section 6. 609.83 of the statutes is amended to read:
SB907,3,8 6609.83 Coverage of drugs and devices ; application of payments.
7Limited service health organizations, preferred provider plans, and defined network
8plans are subject to ss. 632.853, 632.862, and 632.895 (16t).
SB907,7 9Section 7. 632.862 of the statutes is created to read:
SB907,3,11 10632.862 Application of prescription drug payments. (1) Definitions. In
11this section:
SB907,3,1212 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
SB907,3,1313 (b) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
SB907,3,1414 (c) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
SB907,3,21 15(2) Application of payments. A disability insurance policy that offers a
16prescription drug benefit, a self-insured health plan, or a pharmacy benefit manager
17acting on behalf of a disability insurance policy or self-insured health plan shall
18apply to any calculation of an out-of-pocket maximum or to any cost-sharing
19requirement of the policy or plan any amounts paid for prescription drugs that are
20covered under the policy or plan by an enrollee or on behalf of any person covered
21under the policy or plan.
SB907,8 22Section 8 . Initial applicability.
SB907,3,2523 (1) (a) For policies and plans containing provisions inconsistent with this act,
24the act first applies to policy or plan years beginning on January 1 of the year
25following the year in which this paragraph takes effect, except as provided in par. (b).
SB907,4,5
1(b) For policies or plans that are affected by a collective bargaining agreement
2containing provisions inconsistent with this act, this act first applies to policy or plan
3years beginning on the effective date of this paragraph or on the day on which the
4collective bargaining agreement is newly established, extended, modified, or
5renewed, whichever is later.
SB907,9 6Section 9 . Effective date.
SB907,4,87 (1) This act takes effect on the first day of the 4th month beginning after
8publication.
SB907,4,99 (End)
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