2025 - 2026 LEGISLATURE
LRBs0100/1
JPC:emw
ASSEMBLY SUBSTITUTE AMENDMENT 2,
TO ASSEMBLY BILL 54
August 28, 2025 - Offered by Representative Novak.
***AUTHORS SUBJECT TO CHANGE***
AB54-ASA2,1,2
1An Act to create 49.45 (9o) of the statutes; relating to: prior authorization for
2antipsychotic drugs under the Medical Assistance program. Analysis by the Legislative Reference Bureau
This bill prohibits the Department of Health Services from requiring prior authorization for a covered antipsychotic drug for a Medical Assistance recipient who is at least 18 years of age under certain circumstances, including 1) if the antipsychotic drug was previously approved for the recipient at a different dosage; 2) if initial prior authorization for the antipsychotic drug expires for the recipient, and at the time of expiration, the recipient has taken the antipsychotic drug continuously for at least 60 days; and 3) if the recipient was recently discharged from an inpatient hospital, and as an inpatient, the recipient was stabilized on the antipsychotic drug. Currently, DHS administers the Medical Assistance program, which is a joint federal and state program that provides health services to individuals who have limited financial resources.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
AB54-ASA2,13Section 1. 49.45 (9o) of the statutes is created to read: AB54-ASA2,2,4
149.45 (9o) Prior authorization for antipsychotic drugs. (a) In this 2subsection, “antipsychotic drug” means a covered prescription drug that is 3approved by the federal food and drug administration and that is classified as an 4antipsychotic. AB54-ASA2,2,75(b) The department may not require prior authorization for an antipsychotic 6drug under any of the following circumstances for a Medical Assistance recipient 7who is at least 18 years of age: AB54-ASA2,2,981. The antipsychotic drug was previously approved for the recipient at a 9different dosage. AB54-ASA2,2,12102. The recipient was newly enrolled in the Medical Assistance program within 11the past 30 days, and the recipient was taking the antipsychotic drug continuously 12for at least 30 days at the time of enrollment. AB54-ASA2,2,15133. Initial prior authorization for the antipsychotic drug expires for the 14recipient, and at the time of expiration, the recipient has taken the antipsychotic 15drug continuously for at least 60 days. AB54-ASA2,2,17164. The recipient was recently discharged from an inpatient hospital, and as an 17inpatient, the recipient was stabilized on the antipsychotic drug. AB54-ASA2,2,1918(c) 1. Nothing in this subsection otherwise restricts the department’s 19authority to require prior authorization as provided under federal law. AB54-ASA2,2,21202. Nothing in this subsection may be interpreted to conflict with 42 USC 211396a (oo).
