2015 - 2016 LEGISLATURE
August 24, 2015 - Introduced by Senators Kapenga,
Lazich, LeMahieu, Moulton,
Nass, Roth and Stroebel, cosponsored by Representatives Jacque,
Kleefisch, Allen, Ballweg, Bernier, Born, Brandtjen, R. Brooks, Craig,
Czaja, Edming, Gannon, Heaton, Horlacher, Hutton, Jarchow, Knodl,
Knudson, Kooyenga, Kremer, Krug, Kulp, T. Larson, Macco, Murphy, A. Ott,
Petersen, Quinn, Rohrkaste, Sanfelippo, Schraa, Skowronski, Steffen,
Thiesfeldt, Tittl and Vorpagel. Referred to Committee on Health and
1An Act to create
49.45 (49g) of the statutes; relating to: billing the Medical
2Assistance program for prescription drugs by certain entities.
Analysis by the Legislative Reference Bureau
This bill requires certain entities, when billing the Medical Assistance (MA)
program for reimbursement of a prescription drug, to bill the actual acquisition cost
of the prescription drug and the dispensing fee charged under the MA program.
Under current law, the MA program provides coverage for prescription drugs
as a benefit. The federal government, under current federal law, has an agreement
with drug manufacturers to limit the price of certain drugs purchased by covered
entities to the average manufacturer price reduced by any rebate percentage.
"Covered entity" is defined in federal law and, for purposes of this bill, means certain
family planning projects and certain entities that receive funds related to treatment
of sexually-transmitted diseases or tuberculosis. This bill specifies that a covered
entity must charge the actual acquisition cost of a prescription drug and the standard
MA dispensing fee when billing the MA program for reimbursement.
For further information see the state 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:
49.45 (49g) of the statutes is created to read:
49.45 (49g) Billing for prescription drugs.
(a) In this subsection:
1. "Covered entity" has the meaning given in 42 USC 256b
(a) (4) (C) and (K).
2. "Prescription drug" has the meaning given in s. 450.01 (20).
(b) When billing the Medical Assistance program under this subchapter for 5
reimbursement for a prescription drug, a covered entity shall bill the actual 6
acquisition cost of the prescription drug for which coverage is provided under s. 49.46 7
(2) (b) 6. h. and a dispensing fee that is equal to the dispensing fee permitted to be 8
charged for prescription drugs for which coverage is provided under s. 49.46 (2) (b) 9