AB120,8,55 2. For each 12-month benefit period, a deductible for each person of $840.
AB120,8,66 3. After payment of the deductible under subd. 2., all of the following:
AB120,8,87 a. A copayment of $10 for each prescription drug that bears only a generic
8name.
AB120,8,109 b. A copayment of $20 for each prescription drug that does not bear only a
10generic name.
AB120,8,1411 (b) Notwithstanding s. 49.002, if a person who is eligible under this section has
12other available coverage for payment of a prescription drug, this section applies only
13to costs for prescription drugs for the person that are not covered under the person's
14other available coverage.
AB120,8,20 15(4) The department shall devise and distribute a form for application for the
16program under sub. (2), shall determine eligibility for each 12-month benefit period
17of applicants, and shall issue to eligible persons a prescription drug card for use in
18purchasing prescription drugs, as specified in sub. (5). The department shall
19promulgate rules that specify the criteria to be used to determine annual household
20income under sub. (2).
AB120,9,2 21(5) Beginning March 1, 2002, as a condition of participation by a pharmacy or
22pharmacist in the program under ss. 49.45, 49.46, or 49.47, the pharmacy or
23pharmacist may not charge a person who presents a valid prescription order and a
24card indicating that he or she meets eligibility requirements under sub. (2) an

1amount for a prescription drug under the order that exceeds the amounts specified
2in sub. (6) (b).
AB120,9,5 3(6) (a) The charge for a prescription drug shall be calculated at the average
4wholesale price minus 5% or the maximum allowable cost, as determined by the
5department, whichever is less.
AB120,9,76 (b) The amounts that a pharmacy or pharmacist may charge a person specified
7in sub. (2) in a calendar year period for a prescription drug are the following:
AB120,9,118 1. If applicable, a deductible, as specified in sub. (3) (a) 2., for a prescription
9drug that is charged at the rate specified in par. (a), plus a dispensing fee that is equal
10to the dispensing fee permitted to be charged for prescription drugs for which
11coverage is provided under s. 49.46 (2) (b) 6. h.
AB120,9,1312 2. After the deductible under subd. 1. is charged, the copayment, as applicable,
13that is specified in sub. (3) (a) 3. a. or b.
AB120,9,1714 (c) The department shall calculate and transmit to pharmacies and
15pharmacists that are certified providers of medical assistance amounts that may be
16used in calculating charges under par. (a). The department shall periodically update
17this information and transmit the updated amounts to pharmacies and pharmacists.
AB120,9,22 18(7) The department or an entity with which the department contracts may
19enter into a rebate agreement that is modeled on the rebate agreement specified
20under 42 USC 1396r-8 with a drug manufacturer that sells drugs for prescribed use
21in this state. The rebate agreement, if negotiated, shall include all of the following
22as requirements:
AB120,9,2423 (a) That the manufacturer shall make rebate payments for each prescription
24drug of the manufacturer that is prescribed for persons who are eligible under sub.

1(2), to the state treasurer to be credited to the appropriation under s. 20.435 (4) (j),
2each calendar quarter or according to a schedule established by the department.
AB120,10,43 (b) That the amount of the rebate payment shall be determined by a method
4specified in 42 USC 1396r-8 (c).
AB120,10,19 5(8) From the appropriation accounts under s. 20.435 (4) (bv) and (j), beginning
6March 1, 2002, the department shall, under a schedule that is identical to that used
7by the department for payment of pharmacy provider claims under medical
8assistance, provide to pharmacies and pharmacists payments for prescription drugs
9sold by the pharmacies or pharmacists to persons eligible under sub. (2) who have
10paid the deductible specified under sub. (3) (a) 2. The payment for each prescription
11drug under this subsection shall be at the rate specified in sub. (6) (a), minus the
12amount of a copayment charged under sub. (6) (b) 2., plus a dispensing fee, as
13specified in sub. (6) (b) 1. The department shall devise and distribute a form for
14reports by pharmacies and pharmacists under this subsection and may limit
15payment under this subsection to those prescription drugs for which payment claims
16are submitted by pharmacies or pharmacists directly to the department. The
17department may apply to the program under this section the same utilization and
18cost control procedures that apply under rules promulgated by the department to
19medical assistance under subch. IV.
AB120,11,2 20(9) The department shall, under methods promulgated by the department by
21rule, monitor compliance by pharmacies and pharmacists that are certified providers
22of medical assistance with the requirements of sub. (5) and shall annually report to
23the legislature under s. 13.172 (2) concerning the compliance. The report shall
24include information on any pharmacies or pharmacists that discontinue

1participation as certified providers of medical assistance and the reasons given for
2the discontinuance.
AB120,11,4 3(10) (a) The department shall promulgate rules relating to prohibitions on
4fraud that are substantially similar to applicable provisions under s. 49.49 (1) (a).
AB120,11,85 (b) A person who is convicted of violating a rule promulgated by the department
6under par. (a) in connection with that person's furnishing of prescription drugs under
7this section may be fined not more than $25,000, or imprisoned for not more than 7
8years and 6 months, or both.
AB120,11,119 (c) A person other than a person specified in par. (b) who is convicted of violating
10a rule promulgated by the department under par. (a) may be fined not more than
11$10,000, or imprisoned for not more than one year, or both.
AB120,11,17 12(11) If federal law is amended to provide coverage for prescription drugs for
13outpatient care as a benefit under medicare or to provide similar coverage under
14another program, the department shall submit to appropriate standing committees
15of the legislature under s. 13.172 (3) a report that contains an analysis of the
16differences between such a federal program and the program under this section and
17that provides recommendations concerning alignment, if any, of the differences.
AB120,11,22 18(12) After February 28, 2002, and before March 1, 2004, the department may
19not subject a manufacturer that enters into a rebate agreement under sub. (7) to prior
20authorization requirements for a prescription drug under this section that are an
21expansion of prior authorization requirements in effect under the medical assistance
22program on March 1, 2002.
AB120,12,2 23(13) Except as provided in subs. (9) to (12), and except for the department's
24rule-making requirements and authority, the department may enter into a contract

1with an entity to perform the duties and exercise the powers of the department under
2this section.
AB120, s. 15 3Section 15. Nonstatutory provisions.
AB120,13,44 (1) Prescription drug assistance for elderly; administration. Before July 1,
52001, the department of health and family services may develop and submit to the
6department of administration a proposal for expenditure of the funds appropriated
7under section 20.865 (4) (a) of the statutes for administration of the prescription drug
8assistance for elderly program under section 49.688 of the statutes, as created by this
9act. The department of administration may approve, disapprove, or modify and
10approve any proposal it receives under this subsection. If the department of
11administration approves the proposal, the department shall submit the proposal,
12together with any modifications, to the cochairpersons of the joint committee on
13finance. If the cochairpersons of the committee do not notify the secretaries of
14administration and health and family services within 14 working days after
15receiving the proposal that the cochairpersons have scheduled a meeting for the
16purpose of reviewing the proposal, the secretary of administration may transfer from
17the appropriation under section 20.865 (4) of the statutes to the appropriation under
18section 20.435 (4) (a) of the statutes the amount specified in the proposal or any
19proposed modifications of the proposal for expenditure as specified in the proposal
20or any proposed modifications of the proposal and may approve any position
21authority specified in the proposal or any proposed modifications of the proposal. If,
22within 14 working days after receiving the proposal, the cochairpersons notify the
23secretaries of administration and health and family services that the cochairpersons
24have scheduled a meeting for the purpose of reviewing the proposal, the secretary of
25administration may not transfer any amount specified in the proposal or any

1proposed modifications of the proposal from the appropriation under section 20.865
2(4) of the statutes and may not approve any position authority specified in the
3proposal or any proposed modifications of the proposal, except as approved by the
4committee.
AB120, s. 16 5Section 16. Appropriation changes.
AB120,13,116 (1) Prescription drug assistance for elderly; administration. In the schedule
7under section 20.005 (3) of the statutes for the appropriation to the joint committee
8on finance under section 20.865 (4) (a) of the statutes, as affected by the acts of 1999,
9the dollar amount is increased by $2,000,000 for fiscal year 2001-02 to increase
10funding for administration of the prescription drug assistance for elderly program
11under section 49.688 of the statutes, as created by this act.
AB120, s. 17 12Section 17 . Initial applicability.
AB120,13,1613 (1) Medical assistance eligibility. The treatment of section 49.47 (4) (aq), (b)
142m. b., 2r., 2w., and 3., (c) 1. and 3., and (i) 2. (intro.) of the statutes first applies to
15eligibility determinations made for medical assistance on the effective date of this
16subsection.
AB120, s. 18 17Section 18. Effective date. This act takes effect on the 2nd day after
18publication of the biennial budget act, except as follows:
AB120,13,2019 (1) Prescription drug assistance for elderly. The treatment of section 20.435
20(4) (bv) of the statutes takes effect on March 1, 2002.
AB120,13,2321 (2) Medical assistance eligibility. The treatment of section 49.47 (4) (aq), (b)
222m. b., 2r., 2w., and 3., (c) 1. and 3., and (i) 2. (intro.) of the statutes and Section 17
23(1) of this act take effect on March 1, 2002.
AB120,13,2424 (End)
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