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LRB-2198/1
TJD:klm
2021 - 2022 LEGISLATURE
March 23, 2021 - Introduced by Representatives Tittl, Moses, Subeck,
Armstrong, Cabral-Guevara, Dittrich, Krug, Rozar and Wichgers,
cosponsored by Senators Jacque and Carpenter. Referred to Committee on
Health.
AB184,1,4 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 to health insurance cost-sharing
4requirements.
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 by or on behalf of a person covered under
the policy or plan for prescription drugs to any calculation of an out-of-pocket
maximum amount or to any cost-sharing requirement of the policy or plan. This
requirement applies regardless of whether a claim is submitted to the policy or plan
to pay for the prescription drug. 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:
AB184,1 5Section 1. 40.51 (8) of the statutes is amended to read:
AB184,2,36 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
7shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.729, 632.746

1(1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853,
2632.855, 632.862, 632.867, 632.87 (3) to (6), 632.885, 632.89, 632.895 (5m) and (8) to
3(17), and 632.896.
AB184,2 4Section 2. 40.51 (8m) of the statutes is amended to read:
AB184,2,85 40.51 (8m) Every health care coverage plan offered by the group insurance
6board under sub. (7) shall comply with ss. 631.95, 632.729, 632.746 (1) to (8) and (10),
7632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.862,
8632.867, 632.885, 632.89, and 632.895 (11) to (17).
AB184,3 9Section 3. 66.0137 (4) of the statutes is amended to read:
AB184,2,1610 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
11a village provides health care benefits under its home rule power, or if a town
12provides health care benefits, to its officers and employees on a self-insured basis,
13the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
14632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855,
15632.862, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and
16767.513 (4).
AB184,4 17Section 4. 120.13 (2) (g) of the statutes is amended to read:
AB184,2,2118 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
1949.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.729, 632.746 (10) (a) 2. and (b) 2.,
20632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.862, 632.867, 632.87 (4) to (6),
21632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).
AB184,5 22Section 5. 185.983 (1) (intro.) of the statutes is amended to read:
AB184,3,523 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
24cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
25646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,

1601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
2631.95, 632.72 (2), 632.729, 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798,
3632.85, 632.853, 632.855, 632.862, 632.867, 632.87 (2) to (6), 632.885, 632.89,
4632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645,
5and 646, but the sponsoring association shall:
AB184,6 6Section 6. 609.83 of the statutes is amended to read:
AB184,3,9 7609.83 Coverage of drugs and devices ; application of payments.
8Limited service health organizations, preferred provider plans, and defined network
9plans are subject to ss. 632.853, 632.862, and 632.895 (16t) and (16v).
AB184,7 10Section 7. 632.862 of the statutes is created to read:
AB184,3,12 11632.862 Application of prescription drug payments. (1) Definitions. In
12this section:
AB184,3,1413 (a) “Cost-sharing requirement” means a deductible, copayment, or
14coinsurance.
AB184,3,1515 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB184,3,1616 (b) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
AB184,3,1717 (c) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB184,3,25 18(2) Application of payments. A disability insurance policy that offers a
19prescription drug benefit, a self-insured health plan, or a pharmacy benefit manager
20acting on behalf of a disability insurance policy or self-insured health plan shall
21apply to any calculation of an out-of-pocket maximum amount or to any
22cost-sharing requirement of the policy or plan any amounts paid by an enrollee or
23on behalf of any person covered under the policy or plan for prescription drugs that
24are covered under the policy or plan regardless of whether a claim is submitted to the
25policy or plan for the prescription drug.
AB184,8
1Section 8. Initial applicability.
AB184,4,42 (1) (a) For policies and plans containing provisions inconsistent with this act,
3the act first applies to policy or plan years beginning on January 1 of the year
4following the year in which this paragraph takes effect, except as provided in par. (b).
AB184,4,95 (b) For policies or plans that are affected by a collective bargaining agreement
6containing provisions inconsistent with this act, this act first applies to policy or plan
7years beginning on the effective date of this paragraph or on the day on which the
8collective bargaining agreement is newly established, extended, modified, or
9renewed, whichever is later.
AB184,9 10Section 9. Effective date.
AB184,4,1211 (1) This act takes effect on the first day of the 4th month beginning after
12publication.
AB184,4,1313 (End)
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