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2001 - 2002 LEGISLATURE
SENATE SUBSTITUTE AMENDMENT 1,
TO 2001 SENATE BILL 1
January 25, 2001 - Offered by Committee onHealth, Utilities, Veterans and
Military Affairs
.
SB1-SSA1,1,7 1An Act to create 20.435 (4) (bv), 20.435 (4) (j), 20.435 (4) (jb) and 49.688 of the
2statutes; relating to: requiring pharmacies and pharmacists, as a condition of
3medical assistance participation, to charge elderly persons for prescription
4drugs no more than specific amounts; specifying requirements for rebate
5agreements between the department of health and family services and drug
6manufacturers; requiring the exercise of rule-making authority; making
7appropriations; and providing penalties.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB1-SSA1, s. 1 8Section 1. 20.435 (4) (bv) of the statutes is created to read:
SB1-SSA1,1,119 20.435 (4) (bv) Prescription drug assistance for elderly; aids. A sum sufficient
10for payment to pharmacies and pharmacists under s. 49.688 (7) for prescription drug
11assistance for elderly persons.
SB1-SSA1, s. 2 12Section 2. 20.435 (4) (j) of the statutes is created to read:
SB1-SSA1,2,4
120.435 (4) (j) Prescription drug assistance for elderly; manufacturer rebates.
2All moneys received from rebate payments by manufacturers under s. 49.688 (6), to
3be used for payment to pharmacies and pharmacists under s. 49.688 (7) for
4prescription drug assistance for elderly persons.
SB1-SSA1, s. 3 5Section 3. 20.435 (4) (jb) of the statutes is created to read:
SB1-SSA1,2,86 20.435 (4) (jb) Prescription drug assistance for elderly; enrollment fees. All
7moneys received from payment of enrollment fees under s. 49.688 (3), to be used for
8administration of the program under s. 49.688.
SB1-SSA1, s. 4 9Section 4. 49.688 of the statutes is created to read:
SB1-SSA1,2,11 1049.688 Prescription drug assistance for elderly persons. (1) In this
11section:
SB1-SSA1,2,1212 (a) "Generic name" has the meaning given in s. 450.12 (1) (b).
SB1-SSA1,2,1413 (b) "Poverty line" means the nonfarm federal poverty line for the continental
14United States, as defined by the federal department of labor under 42 USC 9902 (2).
SB1-SSA1,2,1815 (c) "Prescription drug" means a prescription drug, as defined in s. 450.01 (20),
16that is included in the drugs specified under s. 49.46 (2) (b) 6. h. and that is
17manufactured by a drug manufacturer that enters into a rebate agreement in force
18under sub. (6).
SB1-SSA1,2,1919 (d) "Prescription order" has the meaning given in s. 450.01 (21).
SB1-SSA1,2,2120 (e) "Program payment rate" means the rate of payment made for the identical
21drug specified under s. 49.46 (2) (b) 6. h., plus 5%.
SB1-SSA1,2,23 22(2) (a) A person to whom all of the following applies is eligible to purchase a
23prescription drug for the amounts specified in sub. (5) (a) 1. and 2.:
SB1-SSA1,2,2424 1. The person is a resident, as defined in s. 27.01 (10) (a), of this state.
SB1-SSA1,2,2525 2. The person is at least 65 years of age.
SB1-SSA1,3,1
13. The person is not a recipient of medical assistance.
SB1-SSA1,3,42 4. The person's annual household income, as determined by the department,
3does not exceed 300% of the federal poverty line for a family the size of the person's
4eligible family.
SB1-SSA1,3,55 5. The person pays the program enrollment fee specified in sub. (3) (a).
SB1-SSA1,3,126 (b) A person to whom par. (a) 1. to 3. and 5. applies, but whose annual household
7income, as determined by the department, exceeds 300% of the federal poverty line
8for a family the size of the persons' eligible family, is eligible to purchase a
9prescription drug at the amounts specified in sub. (5) (a) 4. only during the remaining
10amount of any 12-month period in which the person has first paid the annual
11deductible specified in sub. (3) (b) 2. a. in purchasing prescription drugs at the retail
12price and has then paid the annual deductible specified in sub. (3) (b) 2. b.
SB1-SSA1,3,13 13(3) Program participants shall pay all of the following:
SB1-SSA1,3,1414 (a) For each 12-month benefit period, a program enrollment fee of $20.
SB1-SSA1,3,1815 (b) 1. For each 12-month benefit period, for a person specified in sub. (2) (a),
16a deductible for prescription drugs of $500, except that a person whose annual
17household income, as determined by the department, is 175% or less of the federal
18poverty line for a family the size of the person's eligible family pays no deductible.
SB1-SSA1,3,2019 2. For each 12-month benefit period, for a person specified in sub. (2) (b), a
20deductible for prescription drugs that equals all of the following:
SB1-SSA1,3,2221 a. The difference between the person's annual household income and 300% of
22the federal poverty line for a family the size of the person's eligible family.
SB1-SSA1,3,2323 b. Five hundred dollars.
SB1-SSA1,3,2524 (c) After payment of any applicable deductible under par. (b), all of the
25following:
SB1-SSA1,4,1
11. A copayment of $5 for each prescription drug that bears only a generic name.
SB1-SSA1,4,32 2. A copayment of $10 for each prescription drug that does not bear only a
3generic name.
SB1-SSA1,4,74 (d) Notwithstanding s. 49.002, if a person who is eligible under this section has
5other available coverage for payment of a prescription drug, this section applies only
6to costs for prescription drugs for the person that are not covered under the person's
7other available coverage.
SB1-SSA1,4,13 8(4) The department shall devise and distribute a form for application for the
9program under sub. (2), shall determine eligibility for each 12-month benefit period
10of applicants and shall issue to eligible persons a prescription drug card for use in
11purchasing prescription drugs, as specified in sub. (5). The department shall
12promulgate rules that specify the criteria to be used to determine household income
13under sub. (2) (a) 4. and (b) and (3) (b) 1.
SB1-SSA1,4,18 14(5) (a) Beginning March 1, 2002, as a condition of participation by a pharmacy
15or pharmacist in the program under s. 49.45, 49.46, or 49.47, the pharmacy or
16pharmacist may not charge a person who presents a valid prescription order and a
17card indicating that he or she meets eligibility requirements under sub. (2) an
18amount for a prescription drug under the order that exceeds the following:
SB1-SSA1,4,2119 1. For a deductible, as specified in sub. (3) (b) 1. and 2. b., the program payment
20rate, plus a dispensing fee that is equal to the dispensing fee permitted to be charged
21for prescription drugs for which coverage is provided under s. 49.46 (2) (b) 6. h.
SB1-SSA1,4,2422 2. After any applicable deductible under subd. 1. is charged, the copayment, as
23applicable, that is specified in sub. (3) (c) 1. or 2. No dispensing fee, as specified under
24subd. 1., may be charged to a person under this subdivision.
SB1-SSA1,4,2525 3. For a deductible, as specified in sub. (3) (b) 2. a., the retail price.
SB1-SSA1,5,3
14. After the deductible under subd. 3. is charged, the copayment, as applicable,
2that is specified in sub. (3) (c) 1. or 2. No dispensing fee, as specified under subd. 1.,
3may be charged to a person under this subdivision.
SB1-SSA1,5,74 (b) The department shall calculate and transmit to pharmacies and
5pharmacists that are certified providers of medical assistance amounts that may be
6used in calculating charges under par. (a). The department shall periodically update
7this information and transmit the updated amounts to pharmacies and pharmacists.
SB1-SSA1,5,13 8(6) The department or an entity with which the department contracts shall
9provide to a drug manufacturer that sells drugs for prescribed use in this state
10material designed for use by the manufacturer in entering into a rebate agreement
11with the department or entity that is modeled on the rebate agreement specified
12under 42 USC 1396r-8. A rebate agreement under this subsection shall include all
13of the following as requirements:
SB1-SSA1,5,1914 (a) That the manufacturer shall make rebate payments for each prescription
15drug of the manufacturer that is prescribed for and purchased by persons who meet
16criteria under sub. (2) (a) and persons who meet criteria under sub. (2) (b) and have
17paid the deductible under sub. (3) (b) 2. a., to the state treasurer to be credited to the
18appropriation under s. 20.435 (4) (j), each calendar quarter or according to a schedule
19established by the department.
SB1-SSA1,5,2120 (b) That the amount of the rebate payment shall be determined by a method
21specified in 42 USC 1396r-8 (c).
SB1-SSA1,6,13 22(7) From the appropriation accounts under s. 20.435 (4) (bv) and (j), beginning
23March 1, 2002, the department shall, under a schedule that is identical to that used
24by the department for payment of pharmacy provider claims under medical
25assistance, provide to pharmacies and pharmacists payments for prescription drugs

1sold by the pharmacies or pharmacists to persons eligible under sub. (2) who have
2paid the deductible specified under sub. (3) (b) 1. or 2. or who, under sub. (3) (b) 1.,
3are not required to pay a deductible. The payment for each prescription drug under
4this subsection shall be at the program payment rate, minus any copayment paid by
5the person under sub. (5) (a) 2. or 4., plus a dispensing fee, as specified under sub.
6(5) (a) 1., and plus, if applicable, incentive payments that are similar to those
7provided under s. 49.45 (8v). The department shall devise and distribute a claim
8form for use by pharmacies and pharmacists under this subsection and may limit
9payment under this subsection to those prescription drugs for which payment claims
10are submitted by pharmacists or pharmacies directly to the department. The
11department may apply to the program under this section the same utilization and
12cost control procedures that apply under rules promulgated by the department to
13medical assistance under subch. IV of ch. 49.
SB1-SSA1,6,20 14(8) The department shall, under methods promulgated by the department by
15rule, monitor compliance by pharmacies and pharmacists that are certified providers
16of medical assistance with the requirements of sub. (5) and shall annually report to
17the legislature under s. 13.172 (2) concerning the compliance. The report shall
18include information on any pharmacies or pharmacists that discontinue
19participation as certified providers of medical assistance and the reasons given for
20the discontinuance.
SB1-SSA1,6,22 21(9) (a) The department shall promulgate rules relating to prohibitions on fraud
22that are substantially similar to applicable provisions under s. 49.49 (1) (a).
SB1-SSA1,7,223 (b) A person who is convicted of violating a rule promulgated by the department
24under par. (a) in connection with that person's furnishing of prescription drugs under

1this section may be fined not more than $25,000, or imprisoned for not more than 7
2years and 6 months, or both.
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