LRB-3119/1
TJD:emw
2017 - 2018 LEGISLATURE
November 9, 2017 - Introduced by Representatives Kolste, Subeck, Sinicki,
Zamarripa, Milroy, Anderson, Berceau, Pope, Spreitzer, Considine,
Billings, Horlacher, Brostoff, Hesselbein, Vruwink, Ohnstad, Sargent,
Hintz, Young, Shankland, Zepnick, Riemer, Crowley, Genrich and Hebl,
cosponsored by Senators Erpenbach, Carpenter, Wirch, Larson and
Ringhand. Referred to Committee on Insurance.
AB622,1,3 1An Act to amend 609.83; and to create 632.895 (11g) of the statutes; relating
2to:
prohibiting elimination of covered prescription drugs or devices during a
3contract year for certain health care plans.
Analysis by the Legislative Reference Bureau
This bill prohibits a health insurance policy, known in the bill as a disability
insurance policy, or self-insured governmental health plan from denying or allowing
a pharmacy benefit manager to deny coverage to an insured or plan participant
during a current policy or plan year for a prescribed drug or device if 1) the prescribed
drug or device was covered under the policy or plan for the insured or plan
participant when the insured or plan participant either enrolled in coverage or
renewed coverage, whichever is later and 2) a health care provider who prescribed
the prescribed drug or device states, in writing, that the prescribed drug or device
is more suitable for the insured's or plan participant's condition than alternative
drugs or devices that remain covered under the policy or plan. The bill also prohibits
a policy or plan from subjecting such a prescribed drug or device to exclusions,
limitations, deductibles, copayments, or coinsurance that did not apply to the
prescribed drug or device when the insured or plan participant either enrolled or
renewed coverage in the policy or plan.

This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB622,1 1Section 1. 609.83 of the statutes is amended to read:
AB622,2,4 2609.83 Coverage of drugs and devices. Limited service health
3organizations, preferred provider plans, and defined network plans are subject to s.
4ss. 632.853 and 632.895 (11g).
AB622,2 5Section 2. 632.895 (11g) of the statutes is created to read:
AB622,2,66 632.895 (11g) Maintaining drug or device coverage. (a) In this subsection:
AB622,2,77 1. “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
AB622,2,88 2. “Prescribed drug or device” has the meaning given in s. 450.01 (18).
AB622,2,99 3. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB622,2,1310 (b) No disability insurance policy or self-insured health plan may deny or may
11allow a pharmacy benefit manager to deny coverage to an insured or plan participant
12during a current policy or plan year for a prescribed drug or device if all of the
13following conditions are met:
AB622,2,1614 1. The prescribed drug or device was covered under the policy or plan for the
15insured or plan participant when the insured or plan participant either enrolled in
16coverage or renewed coverage, whichever is later.
AB622,2,2017 2. A health care provider who prescribed the prescribed drug or device states,
18in writing, that the prescribed drug or device is more suitable for the insured's or plan
19participant's condition than alternative drugs or devices that remain covered under
20the policy or plan.
AB622,3,5
1(c) No disability insurance policy or self-insured health plan may subject a
2prescribed drug or device described under par. (b) to exclusions, limitations,
3deductibles, copayments, or coinsurance that did not apply to the prescribed drug or
4device when the insured or plan participant either enrolled or renewed coverage,
5whichever is later, in the policy or plan.
AB622,3,76 (d) 1. Nothing in this subsection prohibits a disability insurance policy or
7self-insured health plan from adding prescribed drugs or devices to its formulary.
AB622,3,118 2. A disability insurance policy or self-insured health plan may remove a
9prescribed drug or device from the formulary of a policy or plan that is newly issued
10to an individual who is not enrolled in the policy or plan at the time the policy or plan
11elects to discontinue coverage of the prescribed drug or device.
AB622,3,1412 (e) Nothing in this subsection prohibits a pharmacist from making a
13substitution of a drug product equivalent under s. 450.13 or making a substitution
14that is otherwise legally authorized.
AB622,3 15Section 3. Initial applicability.
AB622,3,1616 (1) Maintaining coverage of prescribed drugs or devices.
AB622,3,1917 (a) For policies and plans containing provisions inconsistent with this act, the
18act first applies to policy or plan years beginning on January 1 of the year following
19the year in which this paragraph takes effect, except as provided in paragraph (b).
AB622,3,2420 (b) For policies and plans that are affected by a collective bargaining agreement
21containing provisions inconsistent with this act, this act first applies to policy or plan
22years beginning on the effective date of this paragraph or on the day on which the
23collective bargaining agreement is newly established, extended, modified, or
24renewed, whichever is later.
AB622,4 25Section 4. Effective date.
AB622,4,2
1(1) This act takes effect on the first day of the 4th month beginning after
2publication.
AB622,4,33 (End)
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