AB68-ASA2-AA2,102,1211
b. Adequacy of the information sheet and list of navigators received from the
12pharmacy.
AB68-ASA2-AA2,102,1313
c. Helpfulness of a navigator.
AB68-ASA2-AA2,102,1514
d. Ease of access in applying for a patient assistance program and receiving
15insulin from the pharmacy under the program.
AB68-ASA2-AA2,102,1916
2. The commissioner shall develop and conduct a satisfaction survey of
17pharmacies that have dispensed insulin through urgent need safety net programs
18and patient assistance programs. The survey shall include questions about the
19pharmacy's satisfaction with all of the following, if applicable:
AB68-ASA2-AA2,102,2120
a. Timeliness of reimbursement from manufacturers for insulin dispensed by
21the pharmacy under urgent need safety net programs.
AB68-ASA2-AA2,102,2222
b. Ease in submitting insulin orders to manufacturers.
AB68-ASA2-AA2,102,2323
c. Timeliness of receiving insulin orders from manufacturers.
AB68-ASA2-AA2,102,2524
3. The commissioner may contract with a nonprofit entity to develop and
25conduct the surveys under subds. 1. and 2. and to evaluate the survey results.
AB68-ASA2-AA2,103,3
14. No later than July 1, 2024, the commissioner shall submit to the governor
2and the chief clerk of each house of the legislature, for distribution to the legislature
3under s. 13.172 (2), a report on the results of the surveys under subds. 1. and 2.
AB68-ASA2-AA2,103,8
4(9) Penalty. A manufacturer that fails to comply with this section may be
5assessed a penalty of up to $200,000 per month of noncompliance, with the maximum
6penalty increasing to $400,000 per month if the manufacturer continues to be in
7noncompliance after 6 months and increasing to $600,000 per month if the
8manufacturer continues to be in noncompliance after one year.
AB68-ASA2-AA2,103,11
10632.869 Reimbursement to federal drug pricing program participants.
11 (
1) In this section:
AB68-ASA2-AA2,103,1512
(a) “Covered entity” means an entity described in
42 USC 256b (a) (4) (A), (D),
13(E), (J), or (N) that participates in the federal drug pricing program under
42 USC
14256b, a pharmacy of the entity, or a pharmacy contracted with the entity to dispense
15drugs purchased through the federal drug pricing program under
42 USC 256b.
AB68-ASA2-AA2,103,1616
(b) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
AB68-ASA2-AA2,103,18
17(2) Any person, including a pharmacy benefit manager and 3rd-party payer,
18may not do any of the following:
AB68-ASA2-AA2,103,2119
(a) Reimburse a covered entity for a drug that is subject to an agreement under
2042 USC 256b at a rate lower than that paid for the same drug to pharmacies that are
21not covered entities and are similar in prescription volume to the covered entity.
AB68-ASA2-AA2,103,2422
(b) Assess a covered entity any fee, charge back, or other adjustment on the
23basis of the covered entity's participation in the federal drug pricing program under
2442 USC 256b.
AB68-ASA2-AA2,104,1
1632.871 Telehealth services. (1) Definitions. In this section:
AB68-ASA2-AA2,104,22
(a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB68-ASA2-AA2,104,33
(b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB68-ASA2-AA2,104,94
(c) “Telehealth" means a practice of health care delivery, diagnosis,
5consultation, treatment, or transfer of medically relevant data by means of audio,
6video, or data communications that are used either during a patient visit or a
7consultation or are used to transfer medically relevant data about a patient.
8“Telehealth" does not include communications delivered solely by audio-only
9telephone, facsimile machine, or e-mail unless specified otherwise by rule.
AB68-ASA2-AA2,104,16
10(2) Coverage denial prohibited. No disability insurance policy or self-insured
11health plan may deny coverage for a treatment or service provided through
12telehealth on the basis that the treatment or service is provided through telehealth
13if that treatment or service is covered by the policy or plan when provided in person.
14A disability insurance policy or self-insured health plan may limit coverage of
15treatments or services provided through telehealth to those treatments or services
16that are medically necessary.
AB68-ASA2-AA2,104,20
17(3) Certain limitations on telehealth prohibited. A disability insurance
18policy or self-insured health plan may not subject a treatment or service provided
19through telehealth for which coverage is required under sub. (2) to any of the
20following:
AB68-ASA2-AA2,104,2221
(a) Any greater deductible, copayment, or coinsurance amount than would be
22applicable if the treatment or service is provided in person.
AB68-ASA2-AA2,104,2523
(b) Any policy or calendar year or lifetime benefit limit or other maximum
24limitation that is not imposed on other treatments or services covered by the plan
25that are not provided through telehealth.
AB68-ASA2-AA2,105,2
1(c) Prior authorization requirements that are not required for the same
2treatment or service when provided in person.
AB68-ASA2-AA2,105,33
(d) Unique location requirements.
AB68-ASA2-AA2,105,8
4(4) Disclosure of coverage of certain telehealth services. A disability
5insurance policy or self-insured health plan that covers a telehealth treatment or
6service that has no equivalent in-person treatment or service, such as remote patient
7monitoring, shall specify in policy or plan materials the coverage of that telehealth
8treatment or service.
AB68-ASA2-AA2,105,1010
632.895
(6) (title)
Equipment and supplies for treatment of diabetes; insulin.
AB68-ASA2-AA2,412zj
11Section 412zj. 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and
12amended to read:
AB68-ASA2-AA2,105,2313
632.895
(6) (a) Every disability insurance policy
which that provides coverage
14of expenses incurred for treatment of diabetes shall provide coverage for expenses
15incurred by the installation and use of an insulin infusion pump, coverage for all
16other equipment and supplies, including insulin or any other prescription
17medication, used in the treatment of diabetes, and coverage of diabetic
18self-management education programs.
Coverage
Except as provided in par. (b),
19coverage required under this subsection shall be subject to the same exclusions,
20limitations, deductibles, and coinsurance provisions of the policy as other covered
21expenses, except that insulin infusion pump coverage may be limited to the purchase
22of one pump per year and the insurer may require the insured to use a pump for 30
23days before purchase.
AB68-ASA2-AA2,105,2525
632.895
(6) (b) 1. In this paragraph:
AB68-ASA2-AA2,106,2
1a. “Cost sharing” means the total of any deductible, copayment, or coinsurance
2amounts imposed on a person covered under a policy or plan.
AB68-ASA2-AA2,106,33
b. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB68-ASA2-AA2,106,64
2. Every disability insurance policy and self-insured health plan that cover
5insulin and impose cost sharing on prescription drugs may not impose cost sharing
6on insulin in an amount that exceeds $50 for a one-month supply of insulin.
AB68-ASA2-AA2,106,117
3. Nothing in this paragraph prohibits a disability insurance policy or
8self-insured health plan from imposing cost sharing on insulin in an amount less
9than the amount specified under subd. 2. Nothing in this paragraph requires a
10disability insurance policy or self-insured health plan to impose any cost sharing on
11insulin.
AB68-ASA2-AA2,106,1913
632.895
(8) (d) Coverage is required under this subsection despite whether the
14woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c)
, and
15(e), coverage under this subsection may only be subject to exclusions and limitations,
16including
deductibles, copayments and restrictions on excessive charges, that are
17applied to other radiological examinations covered under the disability insurance
18policy.
Coverage under this subsection may not be subject to any deductibles,
19copayments, or coinsurance.
AB68-ASA2-AA2,106,2221
632.895
(13m) Preventive services. (a) In this section, “self-insured health
22plan” has the meaning given in s. 632.85 (1) (c).
AB68-ASA2-AA2,106,2523
(b) Every disability insurance policy, except any disability insurance policy that
24is described in s. 632.745 (11) (b) 1. to 12., and every self-insured health plan shall
25provide coverage for all of the following preventive services:
AB68-ASA2-AA2,107,1
11. Mammography in accordance with sub. (8).
AB68-ASA2-AA2,107,32
2. Genetic breast cancer screening and counseling and preventive medication
3for adult women at high risk for breast cancer.
AB68-ASA2-AA2,107,54
3. Papanicolaou test for cancer screening for women 21 years of age or older
5with an intact cervix.
AB68-ASA2-AA2,107,76
4. Human papillomavirus testing for women who have attained the age of 30
7years but have not attained the age of 66 years.
AB68-ASA2-AA2,107,88
5. Colorectal cancer screening in accordance with sub. (16m).
AB68-ASA2-AA2,107,119
6. Annual tomography for lung cancer screening for adults who have attained
10the age of 55 years but have not attained the age of 80 years and who have health
11histories demonstrating a risk for lung cancer.
AB68-ASA2-AA2,107,1312
7. Skin cancer screening for individuals who have attained the age of 10 years
13but have not attained the age of 22 years.
AB68-ASA2-AA2,107,1514
8. Counseling for skin cancer prevention for adults who have attained the age
15of 18 years but have not attained the age of 25 years.
AB68-ASA2-AA2,107,1716
9. Abdominal aortic aneurysm screening for men who have attained the age of
1765 years but have not attained the age of 75 years and who have ever smoked.
AB68-ASA2-AA2,107,2018
10. Hypertension screening for adults and blood pressure testing for adults, for
19children under the age of 3 years who are at high risk for hypertension, and for
20children 3 years of age or older.
AB68-ASA2-AA2,107,2221
11. Lipid disorder screening for minors 2 years of age or older, adults 20 years
22of age or older at high risk for lipid disorders, and all men 35 years of age or older.
AB68-ASA2-AA2,107,2523
12. Aspirin therapy for cardiovascular health for adults who have attained the
24age of 55 years but have not attained the age of 80 years and for men who have
25attained the age of 45 years but have not attained the age of 55 years.
AB68-ASA2-AA2,108,2
113. Behavioral counseling for cardiovascular health for adults who are
2overweight or obese and who have risk factors for cardiovascular disease.
AB68-ASA2-AA2,108,33
14. Type II diabetes screening for adults with elevated blood pressure.
AB68-ASA2-AA2,108,54
15. Depression screening for minors 11 years of age or older and for adults when
5follow-up supports are available.
AB68-ASA2-AA2,108,76
16. Hepatitis B screening for minors at high risk for infection and adults at high
7risk for infection.
AB68-ASA2-AA2,108,98
17. Hepatitis C screening for adults at high risk for infection and onetime
9hepatitis C screening for adults born in any year from 1945 to 1965.
AB68-ASA2-AA2,108,1310
18. Obesity screening and management for all minors and adults with a body
11mass index indicating obesity, counseling and behavioral interventions for obese
12minors who are 6 years of age or older, and referral for intervention for obesity for
13adults with a body mass index of 30 kilograms per square meter or higher.
AB68-ASA2-AA2,108,1514
19. Osteoporosis screening for all women 65 years of age or older and for women
15at high risk for osteoporosis under the age of 65 years.
AB68-ASA2-AA2,108,1616
20. Immunizations in accordance with sub. (14).
AB68-ASA2-AA2,108,1917
21. Anemia screening for individuals 6 months of age or older and iron
18supplements for individuals at high risk for anemia and who have attained the age
19of 6 months but have not attained the age of 12 months.
AB68-ASA2-AA2,108,2120
22. Fluoride varnish for prevention of tooth decay for minors at the age of
21eruption of their primary teeth.
AB68-ASA2-AA2,108,2322
23. Fluoride supplements for prevention of tooth decay for minors 6 months of
23age or older who do not have fluoride in their water source.
AB68-ASA2-AA2,108,2424
24. Gonorrhea prophylaxis treatment for newborns.
AB68-ASA2-AA2,108,2525
25. Health history and physical exams for prenatal visits and for minors.
AB68-ASA2-AA2,109,2
126. Length and weight measurements for newborns and height and weight
2measurements for minors.
AB68-ASA2-AA2,109,43
27. Head circumference and weight-for-length measurements for newborns
4and minors who have not attained the age of 3 years.
AB68-ASA2-AA2,109,55
28. Body mass index for minors 2 years of age or older.
AB68-ASA2-AA2,109,76
29. Blood pressure measurements for minors 3 years of age or older and a blood
7pressure risk assessment at birth.
AB68-ASA2-AA2,109,98
30. Risk assessment and referral for oral health issues for minors who have
9attained the age of 6 months but have not attained the age of 7 years.
AB68-ASA2-AA2,109,1110
31. Blood screening for newborns and minors who have not attained the age of
112 months.
AB68-ASA2-AA2,109,1212
32. Screening for critical congenital health defects for newborns.
AB68-ASA2-AA2,109,1313
33. Lead screenings in accordance with sub. (10).
AB68-ASA2-AA2,109,1514
34. Metabolic and hemoglobin screening and screening for phenylketonuria,
15sickle cell anemia, and congenital hypothyroidism for minors including newborns.
AB68-ASA2-AA2,109,1716
35. Tuberculin skin test based on risk assessment for minors one month of age
17or older.
AB68-ASA2-AA2,109,1918
36. Tobacco counseling and cessation interventions for individuals who are 5
19years of age or older.
AB68-ASA2-AA2,109,2120
37. Vision and hearing screening and assessment for minors including
21newborns.
AB68-ASA2-AA2,109,2322
38. Sexually transmitted infection and human immunodeficiency virus
23counseling for sexually active minors.
AB68-ASA2-AA2,110,3
139. Risk assessment for sexually transmitted infection for minors who are 10
2years of age or older and screening for sexually transmitted infection for minors who
3are 16 years of age or older.
AB68-ASA2-AA2,110,44
40. Alcohol misuse screening and counseling for minors 11 years of age or older.
AB68-ASA2-AA2,110,65
41. Autism screening for minors who have attained the age of 18 months but
6have not attained the age of 25 months.
AB68-ASA2-AA2,110,77
42. Developmental screening and surveillance for minors including newborns.
AB68-ASA2-AA2,110,88
43. Psychosocial and behavioral assessment for minors including newborns.
AB68-ASA2-AA2,110,109
44. Alcohol misuse screening and counseling for pregnant adults and a risk
10assessment for all adults.
AB68-ASA2-AA2,110,1211
45. Fall prevention and counseling and preventive medication for fall
12prevention for community-dwelling adults 65 years of age or older.