SB70-AA3,129,1916
4. Maintain the privacy of all information received from an individual applying
17for or participating in the patient assistance program and not sell, share, or
18disseminate the information unless required under this section or authorized, in
19writing, by the individual.
SB70-AA3,129,2120
(b)
Eligible individual. An individual shall be eligible to receive insulin under
21a patient assistance program if all of the following conditions are met:
SB70-AA3,129,2222
1. The individual is a resident of this state.
SB70-AA3,129,2523
2. The individual, or the individual's parent or legal guardian if the individual
24is under the age of 18, has a valid Wisconsin driver's license or state identification
25card.
SB70-AA3,130,1
13. The individual has a valid insulin prescription.
SB70-AA3,130,42
4. The family income of the individual does not exceed 400 percent of the
3poverty line as defined and revised annually under
42 USC 9902 (2) for a family the
4size of the individual's family.
SB70-AA3,130,55
5. The individual is not receiving public assistance under ch. 49.
SB70-AA3,130,116
6. The individual is not eligible to receive health care through a federally
7funded program or receive prescription drug benefits through the U.S. department
8of veterans affairs, except that this subdivision does not apply to an individual who
9is enrolled in a policy under Part D of Medicare under
42 USC 1395w-101 et seq. if
10the individual has spent at least $1,000 on prescription drugs in the current calendar
11year.
SB70-AA3,130,1612
7. The individual is not enrolled in prescription drug coverage through an
13individual or group health plan that limits the total cost sharing amount, including
14copayments, deductibles, and coinsurance, that an enrollee is required to pay for a
1530-day supply of insulin to no more than $75, regardless of the type or amount of
16insulin needed.
SB70-AA3,130,2517
(c)
Application for patient assistance program. 1. An individual may apply to
18participate in a patient assistance program by filing an application with the
19manufacturer that established the patient assistance program, the individual's
20health care practitioner if the practitioner participates in the patient assistance
21program, or a navigator included on the list under sub. (8) (c).
A health care
22practitioner or navigator shall immediately submit the application to the
23manufacturer. Upon receipt of an application, the manufacturer shall determine the
24individual's eligibility under par. (b) and, except as provided in subd. 2., notify the
25individual of the determination no later than 10 days after receipt of the application.
SB70-AA3,131,6
12. If necessary to determine the individual's eligibility under par. (b), the
2manufacturer may request additional information from an individual who has filed
3an application under subd. 1. no later than 5 days after receipt of the application.
4Upon receipt of the additional information, the manufacturer shall determine the
5individual's eligibility under par. (b) and notify the individual of the determination
6no later than 3 days after receipt of the requested information.
SB70-AA3,131,127
3. Except as provided in subd. 5., if the manufacturer determines under subd.
81. or 2. that the individual is eligible for the patient assistance program, the
9manufacturer shall provide the individual with a statement of eligibility. The
10statement of eligibility shall be valid for 12 months and may be renewed upon a
11determination by the manufacturer that the individual continues to meet the
12eligibility requirements under par. (b).
SB70-AA3,131,2313
4. If the manufacturer determines under subd. 1. or 2. that the individual is not
14eligible for the patient assistance program, the manufacturer shall provide the
15reason for the determination in the notification under subd. 1. or 2. The individual
16may appeal the determination by filing an appeal with the commissioner that shall
17include all of the information provided to the manufacturer under subds. 1. and 2.
18The commissioner shall establish procedures for deciding appeals under this
19subdivision. The commissioner shall issue a decision no later than 10 days after the
20appeal is filed, and the commissioner's decision shall be final. If the commissioner
21determines that the individual meets the eligibility requirements under par. (b), the
22manufacturer shall provide the individual with the statement of eligibility described
23in subd. 3.
SB70-AA3,132,724
5. In the case of an individual who has prescription drug coverage through an
25individual or group health plan,
if the manufacturer determines under subd. 1. or 2.
1that the individual is eligible for the patient assistance program but also determines
2that the individual's insulin needs are better addressed through the use of the
3manufacturer's copayment assistance program rather than the patient assistance
4program, the manufacturer shall inform the individual of the determination and
5provide the individual with the necessary coupons to submit to a pharmacy. The
6individual may not be required to pay more than the copayment amount specified in
7par. (d) 2.
SB70-AA3,132,148
(d)
Provision of insulin under a patient assistance program. 1. Upon receipt
9from an individual of the eligibility statement described in par. (c) 3. and a valid
10insulin prescription, a pharmacy shall submit an order containing the name of the
11insulin and daily dosage amount to the manufacturer. The pharmacy shall include
12with the order the pharmacy's name, shipping address, office telephone number, fax
13number, email address, and contact name, as well as any days or times when
14deliveries are not accepted by the pharmacy.
SB70-AA3,132,2315
2. Upon receipt of an order meeting the requirements under subd. 1., the
16manufacturer shall send the pharmacy a 90-day supply of insulin, or lesser amount
17if requested in the order, at no charge to the individual or pharmacy. The pharmacy
18shall dispense the insulin to the individual associated with the order. The insulin
19shall be dispensed at no charge to the individual, except that the pharmacy may
20collect a copayment from the individual to cover the pharmacy's costs for processing
21and dispensing in an amount not to exceed $50 for each 90-day supply of insulin.
22The pharmacy may not seek reimbursement from the manufacturer or a 3rd-party
23payer.
SB70-AA3,133,3
13. The pharmacy may submit a reorder to the manufacturer if the individual's
2eligibility statement described in par. (c) 3. has not expired. The reorder shall be
3treated as an order for purposes of subd. 2.
SB70-AA3,133,64
4. Notwithstanding subds. 2. and 3., a manufacturer may send the insulin
5directly to the individual if the manufacturer provides a mail-order service option,
6in which case the pharmacy may not collect a copayment from the individual.
SB70-AA3,133,9
7(4) Exceptions. (a) This section does not apply to a manufacturer that shows
8to the commissioner's satisfaction that the manufacturer's annual gross revenue
9from insulin sales in this state does not exceed $2,000,000.
SB70-AA3,133,1410
(b) A manufacturer may not be required to make an insulin product available
11under sub. (2) or (3) if the wholesale acquisition cost of the insulin product does not
12exceed $8, as adjusted annually based on the U.S. consumer price index for all urban
13consumers, U.S. city average, per milliliter or the applicable national council for
14prescription drug programs' plan billing unit.
SB70-AA3,133,17
15(5) Confidentiality. All medical information solicited or obtained by any
16person under this section shall be subject to the applicable provisions of state law
17relating to confidentiality of medical information, including s. 610.70.
SB70-AA3,133,23
18(6) Reimbursement prohibition. No person, including a manufacturer,
19pharmacy, pharmacist, or 3rd-party administrator, as part of participating in an
20urgent need safety net program or patient assistance program may request or seek,
21or cause another person to request or seek, any reimbursement or other
22compensation for which payment may be made in whole or in part under a federal
23health care program, as defined in
42 USC 1320a-7b (f).
SB70-AA3,134,3
1(7) Reports. (a) Annually, no later than March 1, each manufacturer shall
2report to the commissioner all of the following information for the previous calendar
3year:
SB70-AA3,134,54
1. The number of individuals who received insulin under the manufacturer's
5urgent need safety net program.
SB70-AA3,134,86
2. The number of individuals who sought assistance under the manufacturer's
7patient assistance program and the number of individuals who were determined to
8be ineligible under sub. (3) (c) 4.
SB70-AA3,134,109
3. The wholesale acquisition cost of the insulin provided by the manufacturer
10through the urgent need safety net program and patient assistance program.
SB70-AA3,134,1411
(b) Annually, no later than April 1, the commissioner shall submit to the
12governor and the chief clerk of each house of the legislature, for distribution to the
13legislature under s. 13.172 (2), a report on the urgent need safety net programs and
14patient assistance programs that includes all of the following:
SB70-AA3,134,1515
1. The information provided to the commissioner under par. (a).
SB70-AA3,134,1716
2. The penalties assessed under sub. (9) during the previous calendar year,
17including the name of the manufacturer and amount of the penalty.
SB70-AA3,134,22
18(8) Additional responsibilities of commissioner. (a)
Application form. The
19commissioner shall make the application form described in sub. (2) (c) 1. a. available
20on the office's website and shall make the form available to pharmacies and health
21care providers who prescribe or dispense insulin, hospital emergency departments,
22urgent care clinics, and community health clinics.
SB70-AA3,134,2523
(b)
Public outreach. 1. The commissioner shall conduct public outreach to
24create awareness of the urgent need safety net programs and patient assistance
25programs.
SB70-AA3,135,2
12. The commissioner shall develop and make available on the office's website
2an information sheet that contains all of the following information:
SB70-AA3,135,43
a. A description of how to access insulin through an urgent need safety net
4program.
SB70-AA3,135,55
b. A description of how to access insulin through a patient assistance program.
SB70-AA3,135,76
c. Information on how to contact a navigator for assistance in accessing insulin
7through an urgent need safety net program or patient assistance program.
SB70-AA3,135,98
d. Information on how to contact the commissioner if a manufacturer
9determines that an individual is not eligible for a patient assistance program.
SB70-AA3,135,1110
e. A notification that an individual may contact the commissioner for more
11information or assistance in accessing ongoing affordable insulin options.
SB70-AA3,135,1812
(c)
Navigators. The commissioner shall develop a training program to provide
13navigators with information and the resources necessary to assist individuals in
14accessing appropriate long-term insulin options. The commissioner shall compile
15a list of navigators that have completed the training program and are available to
16assist individuals in accessing affordable insulin coverage options. The list shall be
17made available on the office's website and to pharmacies and health care
18practitioners who dispense and prescribe insulin.
SB70-AA3,135,2419
(d)
Satisfaction surveys. 1. The commissioner shall develop and conduct a
20satisfaction survey of individuals who have accessed insulin through urgent need
21safety net programs and patient assistance programs. The survey shall ask whether
22the individual is still in need of a long-term solution for affordable insulin and shall
23include questions about the individual's satisfaction with all of the following, if
24applicable:
SB70-AA3,135,2525
a. Accessibility to urgent-need insulin.
SB70-AA3,136,2
1b. Adequacy of the information sheet and list of navigators received from the
2pharmacy.
SB70-AA3,136,33
c. Helpfulness of a navigator.
SB70-AA3,136,54
d. Ease of access in applying for a patient assistance program and receiving
5insulin from the pharmacy under the patient assistance program.
SB70-AA3,136,96
2. The commissioner shall develop and conduct a satisfaction survey of
7pharmacies that have dispensed insulin through urgent need safety net programs
8and patient assistance programs. The survey shall include questions about the
9pharmacy's satisfaction with all of the following, if applicable:
SB70-AA3,136,1110
a. Timeliness of reimbursement from manufacturers for insulin dispensed by
11the pharmacy under urgent need safety net programs.
SB70-AA3,136,1212
b. Ease in submitting insulin orders to manufacturers.
SB70-AA3,136,1313
c. Timeliness of receiving insulin orders from manufacturers.
SB70-AA3,136,1514
3. The commissioner may contract with a nonprofit entity to develop and
15conduct the surveys under subds. 1. and 2. and to evaluate the survey results.
SB70-AA3,136,1816
4. No later than July 1, 2026, the commissioner shall submit to the governor
17and the chief clerk of each house of the legislature, for distribution to the legislature
18under s. 13.172 (2), a report on the results of the surveys under subds. 1. and 2.
SB70-AA3,136,23
19(9) Penalty. A manufacturer that violates this section may be required to
20forfeit not more than $200,000 per month of violation, with the maximum forfeiture
21increasing to $400,000 per month if the manufacturer continues to be in violation
22after 6 months and increasing to $600,000 per month if the manufacturer continues
23to be in violation after one year.
SB70-AA3,148
24Section
148. 632.87 (8) of the statutes is created to read:
SB70-AA3,136,2525
632.87
(8) (a) In this subsection:
SB70-AA3,137,1
11. “Health care provider” has the meaning given in s. 146.81 (1) (a) to (hp).
SB70-AA3,137,32
2. “Substance abuse counselor” means a substance abuse counselor certified
3under s. 440.88.
SB70-AA3,137,84
(b) No policy, plan, or contract may exclude coverage for alcoholism or other
5drug abuse treatment or services provided by a substance abuse counselor within the
6scope of the substance abuse counselor's education and training if the policy, plan,
7or contract covers the alcoholism or other drug abuse treatment or services when
8provided by another health care provider.
SB70-AA3,149
9Section
149. 632.871 of the statutes is created to read:
SB70-AA3,137,10
10632.871 Telehealth services. (1)
Definitions. In this section:
SB70-AA3,137,1111
(a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
SB70-AA3,137,1312
(b) “Self-insured health plan” means a self-insured health plan of the state or
13a county, city, village, town, or school district.
SB70-AA3,137,1914
(c) “Telehealth" means a practice of health care delivery, diagnosis,
15consultation, treatment, or transfer of medically relevant data by means of audio,
16video, or data communications that are used either during a patient visit or a
17consultation or are used to transfer medically relevant data about a patient.
18“Telehealth" does not include communications delivered solely by audio-only
19telephone, facsimile machine, or email unless specified otherwise by rule.
SB70-AA3,138,2
20(2) Coverage denial prohibited. No disability insurance policy or self-insured
21health plan may deny coverage for a treatment or service provided through
22telehealth on the basis that the treatment or service is provided through telehealth
23if that treatment or service is covered by the disability insurance policy or
24self-insured health plan when provided in person. A disability insurance policy or
1self-insured health plan may limit coverage of treatments or services provided
2through telehealth to those treatments or services that are medically necessary.
SB70-AA3,138,6
3(3) Certain limitations on telehealth prohibited. A disability insurance
4policy or self-insured health plan may not subject a treatment or service provided
5through telehealth for which coverage is required under sub. (2) to any of the
6following:
SB70-AA3,138,87
(a) Any greater deductible, copayment, or coinsurance amount than would be
8applicable if the treatment or service is provided in person.
SB70-AA3,138,129
(b) Any policy or calendar year or lifetime benefit limit or other maximum
10limitation that is not imposed on other treatments or services covered by the
11disability insurance policy or self-insured health plan that are not provided through
12telehealth.
SB70-AA3,138,1413
(c) Prior authorization requirements that are not required for the same
14treatment or service when provided in person.
SB70-AA3,138,1515
(d) Unique location requirements.
SB70-AA3,138,20
16(4) Disclosure of coverage of certain telehealth services. A disability
17insurance policy or self-insured health plan that covers a telehealth treatment or
18service that has no equivalent in-person treatment or service, such as remote patient
19monitoring, shall specify in policy or plan materials the coverage of that telehealth
20treatment or service.
SB70-AA3,9123
21Section 9123.
Nonstatutory provisions; Insurance.
SB70-AA3,139,322
(1)
Prescription drug importation program. The commissioner of insurance
23shall submit the first report required under s. 601.575 (5) by the next January 1 or
24July 1, whichever is earliest, that is at least 180 days after the date the prescription
25drug importation program is fully operational under s. 601.575 (4). The
1commissioner of insurance shall include in the first 3 reports submitted under s.
2601.575 (5) information on the implementation of the audit functions under s.
3601.575 (1) (n).
SB70-AA3,139,74
(2)
Public option health insurance plan. The office of the commissioner of
5insurance may expend from the appropriation under s. 20.145 (1) (a) in fiscal year
62023-24 not more than $1,000,000 for the development of a public option health
7insurance plan.
SB70-AA3,139,108
(3)
Prescription drug purchasing entity. During the 2023-2025 fiscal
9biennium, the office of the commissioner of insurance shall conduct a study on the
10viability of creating or implementing a state prescription drug purchasing entity.
SB70-AA3,139,1212
(1)
Telehealth parity.
SB70-AA3,139,1613
(a) For policies and plans containing provisions inconsistent with the
14treatment of s. 632.871, the treatment of s. 632.871 first applies to policy or plan
15years beginning on January 1 of the year following the year in which this paragraph
16takes effect, except as provided in par. (b
).
SB70-AA3,139,2117
(b) For policies and plans that are affected by a collective bargaining agreement
18containing provisions inconsistent with the treatment of s. 632.871, the treatment
19of s. 632.871 first applies to policy or plan years beginning on the effective date of this
20paragraph or on the day on which the collective bargaining agreement is newly
21established, extended, modified, or renewed, whichever is later.
SB70-AA3,139,2222
(2)
Substance abuse counselor coverage.
SB70-AA3,140,223
(a) For policies and plans containing provisions inconsistent with the
24treatment of s. 632.87 (8), the treatment of s. 632.87 (8) first applies to policy or plan
1years beginning on January 1 of the year following the year in which this paragraph
2takes effect, except as provided in par. (b
).
SB70-AA3,140,73
(b) For policies and plans that are affected by a collective bargaining agreement
4containing provisions inconsistent with the treatment of s. 632.87 (8), the treatment
5of s. 632.87 (8) first applies to policy or plan years beginning on the effective date of
6this paragraph or on the day on which the collective bargaining agreement is newly
7established, extended, modified, or renewed, whichever is later.
SB70-AA3,140,88
(3)
Application of manufacturer discounts.
SB70-AA3,140,129
(a) For policies and plans containing provisions inconsistent with the
10treatment of s. 632.862, the treatment of s. 632.862 first applies to policy or plan
11years beginning on January 1 of the year following the year in which this paragraph
12takes effect, except as provided in par. (b
).
SB70-AA3,140,1713
(b) For policies or plans that are affected by a collective bargaining agreement
14containing provisions inconsistent with the treatment of s. 632.862, the treatment
15of s. 632.862 first applies to policy or plan years beginning on the effective date of this
16paragraph or on the day on which the collective bargaining agreement is newly
17established, extended, modified, or renewed, whichever is later.
SB70-AA3,140,2119
(1)
Substance abuse counselor coverage. The treatment of s. 632.87 (8) and
20Section 9323 (2
) of this act take effect on the first day of the 4th month beginning
21after publication.”.
SB70-AA3,140,24
23“
Section
150. 20.005 (3) (schedule) of the statutes: at the appropriate place,
24insert the following amounts for the purposes indicated:
-
See PDF for table ![PDF](https://docs.legis.wisconsin.gov/assets/image/file_acrobat.gif)
SB70-AA3,151
1Section
151. 20.115 (7) (gc) of the statutes is amended to read:
SB70-AA3,141,42
20.115
(7) (gc)
Industrial hemp
and marijuana. All moneys received under s.
394.55 for regulation of activities relating to industrial hemp under s. 94.55
and to
4marijuana under s. 94.56.
SB70-AA3,152
5Section
152. 20.115 (7) (ge) of the statutes is created to read:
SB70-AA3,142,26
20.115
(7) (ge)
Marijuana producers and processors; official logotype. All
7moneys received under s. 94.56 for regulation of activities relating to marijuana
1under s. 94.56, for conducting public awareness campaigns under s. 94.56, and for
2the creation of a logotype under s. 100.145.