AB857: Bill Text

AB857,6,12 (b) A person may apply to the department, on a form provided by the department, for a determination of eligibility and issuance of a prescription drug card for purchase of prescription drugs under this section.

AB857,6,17 (3) The department shall devise and distribute a form for applying for the program under sub. (2), shall determine eligibility for each 12-month benefit period of applicants, and, after payment by the applicant of a program enrollment fee of $20 for each 12-month benefit period, shall issue to eligible persons a prescription drug card for use in purchasing prescription drugs, as specified in sub. (4).

AB857,6,23 (4) Beginning May 1, 2003, as a condition of participation by a pharmacy or pharmacist in the program under ss. 49.45, 49.46, or 49.47, the pharmacy or pharmacist may not charge a person who presents a valid prescription order and a card indicating that he or she meets eligibility requirements under sub. (2) an amount for a prescription drug under the order that exceeds the amounts specified in sub. (5) (a).

AB857,6,25 (5) (a) The amounts that a pharmacy or pharmacist may charge a person specified in sub. (3) in a 12-month period for a prescription drug are the following:

AB857,7,1 1. After April 31, 2003, and before December 1, 2003, the lesser of the following:

AB857,7,5 a. The average wholesale price minus 11.25% or the maximum allowable cost, as determined by the department, whichever is less, plus a dispensing fee that is specified by the department but is not less than the dispensing fee paid under the medical assistance program.

AB857,7,7 b. The usual and customary charge of the pharmacy or pharmacist for the proscription drug.

AB857,7,15 2. After November 30, 2003, the rate specified in subd. 1., plus the dispensing fee specified in subd. 1., minus the amount of any rebate payment made by a manufacturer or labeler that is applicable to the prescription drug, as determined by the department. In determining the amount by which a prescription drug shall be discounted under this subdivision, the department shall consider an average of all rebate payments made under the program, as weighted by the sales of prescription drugs subject to the rebates over the most recent 12-month period for which the information is available.

AB857,7,19 (b) The department shall calculate and transmit to pharmacies and pharmacists that are certified providers of medical assistance amounts that may be used in calculating charges under par. (a). The department shall periodically update this information and transmit the updated amounts to pharmacies and pharmacists.

AB857,8,12 (6) (a) The department or an entity with which the department contracts may enter into a rebate agreement that takes into consideration the rebate agreement specified under 42 USC 1396r-8, the average wholesale price of prescription drugs, and any other available information on prescription drug prices and price discounts, with a manufacturer that sells prescription drugs in this state or with a labeler that repackages prescription drugs for sale in this state. The department or the entity with which the department contracts may also enter into an agreement with another state or with a private organization that represents another state, to negotiate rebate agreements with manufacturers and labelers for prescription drugs produced by the manufacturer or repackaged by the labelers that are purchased by persons who are eligible under sub. (2). In negotiating a rebate agreement, the department or entity with which the department contracts may consider the potential effect of the agreement on expenditures under medical assistance. A rebate agreement, if negotiated under this paragraph, shall require that the manufacturer or labeler make rebate payments for each prescription drug of the manufacturer or labeler that is purchased by persons who are eligible under sub. (2), to the state treasurer to be credited to the appropriation under s. 20.435 (4) (jf), each calendar quarter or according to a schedule established by the department.

AB857,8,17 (b) The department shall collect from pharmacies and pharmacists utilization data necessary to calculate the amounts to be rebated under a rebate agreement under par. (a). Any patient-identifiable data, as defined in s. 153.50 (1) (b) 1. or 2. or as specified in s. 153.50 (3) (b) 1. to 7., that is collected under this paragraph shall be treated as a patient health care record for purposes of s. 146.82.

AB857,8,22 (c) If a manufacturer or labeler elects not to enter into a rebate agreement under par. (a), the department shall determine, under procedures established by rule by the department under s. 49.45 (53), whether to subject the prescription drugs produced by the manufacturer or repackaged by the labeler to prior authorization requirements under the medical assistance program.

AB857,9,2 (d) The department may disseminate to the public, by use of the Internet or other means, information that specifies the names of manufacturers or labelers that elect not to enter into rebate agreements and the prices at which the most frequently used prescription drugs are available to persons issued a prescription drug card under sub. (3).

AB857,9,8 (e) The department shall disseminate to physicians, pharmacies, pharmacists, and, as determined by the department, other health professionals information about the relative cost of prescription drugs produced by manufacturers or repackaged by labelers that enter into rebate agreements in comparison with the cost of prescription drugs produced by manufacturers or repackaged by labelers that do not enter into rebate agreements.

AB857,9,14 (f) l. If a discrepancy exists in the manufacturer's or labeler's favor between the amount claimed by a pharmacy or pharmacist under sub. (7) and the amount rebated by the manufacturer or labeler under this subsection, the department may hire an independent auditor who is agreed on by the parties to review the discrepancy. If the discrepancy continues following the audit, the manufacturer or labeler shall justify the reason for the discrepancy or pay to the department any additional amount due.

AB857,9,22 2. If a discrepancy exists that is not in favor of the manufacturer or labeler in the information provided by the department to the manufacturer or labeler regarding the manufacturer's or labeler's rebate, the manufacturer or labeler may hire an independent auditor who is agreed on by the parties to verify the accuracy of the data supplied by the department. If a discrepancy continues following the audit, the department shall justify the reason for the discrepancy to the manufacturer or labeler or refund to the manufacturer or labeler any excess payment made by the manufacturer or labeler.

AB857,9,24 3. If a controversy continues after the procedures under subd. 1. or 2. have been carried out, the department or the manufacturer or labeler may request a hearing before the division of hearings and appeals of the department of administration as a contested case under ch. 227.

AB857,10,15 (7) From revenue received under the appropriation account under s. 20.435 (4) (jf), the department shall, on a weekly or biweekly basis, pay a pharmacy or pharmacist for a prescription drug purchased as specified under sub. (4) an amount that is equal to the pharmacy's or pharmacists share of the rebate amount, if any, for the prescription drug, as determined by the department under sub. (5) (a) 2. The department shall devise and distribute a form for reports by pharmacies and pharmacists under this subsection and may limit payment under this subsection to those prescription drugs for which payment claims are submitted by pharmacies or pharmacists directly to the department. The department may apply to the program under this section the same utilization and cost control procedures that apply under rules promulgated by the department to medical assistance under subch. IV. The department may not impose transaction charges on pharmacies or pharmacists that submit claims or receive payments under this subsection.

AB857,10,16 (8) The department shall do all of the following:

AB857,10,22 (a) Under methods promulgated by the department by rule, monitor compliance by pharmacies and pharmacists that are certified providers of medical assistance with the requirements of sub. (4) and report annually to the legislature under s. 13.172 (2) concerning the compliance. The report shall include information on any pharmacies or pharmacists that discontinue participation as certified providers of medical assistance and the reasons given for the discontinuance.

AB857,10,25 (b) Request from the secretary of the federal department of health and human services a waiver of any federal medicaid laws necessary to implement prior authorization requirements specified in sub. (6) (c).

AB857,11,3 (c) Promote the use of efficacious and reduced-cost prescription drugs, taking into consideration differential dispensing fees, administrative overhead, and incentive payments.

AB857,11,5 (d) Undertake outreach efforts to build public awareness of the program under this section and to maximize enrollment by eligible persons.

AB857,11,7 (e) Promulgate rules relating to prohibitions on fraud that are substantially similar to applicable provisions under s. 49.49 (1) (a).

AB857,11,11 (9) The department may, except as provided in subs. (6) (c) and (8), and except for the department's rule-making requirements and authority, enter into a contract with an entity to perform the duties and exercise the powers of the department under this section.

AB857,11,15 (10) (a) A person who is convicted of violating a rule promulgated by the department under sub. (8) (e) in connection with that person's furnishing of prescription drugs under this section may be fined not more than $25,000, or imprisoned for not more than 7 years and 6 months, or both.

AB857,11,18 (b) A person other than a person specified in par. (a) who is convicted of violating a rule promulgated by the department under sub. (8) (e) may be fined not more than $10,000, or imprisoned for not more than one year, or both.

AB857, s. 5 Section 5. 146.82 (2) (a) 17. of the statutes is amended to read:

AB857,11,20 146.82 (2) (a) 17. To the department under s. 49.689 (6) (b) or 50.53 (2).

AB857, s. 6 Section 6. 450.02 (2) of the statutes is renumbered 450.02 (2) (intro.) and amended to read:

AB857,11,24 450.02 (2) (intro.) The board shall adopt rules defining promulgate all of the following rules, which apply to all applicants for licensure under s. 450.05:

AB857,12,2 (a) Defining the active practice of pharmacy. The rules shall apply to all applicants for licensure under s. 450.05.

AB857, s. 7 Section 7. 450.02 (2) (b) of the statutes is created to read:

AB857,12,7 450.02 (2) (b) Requiring disclosure by a pharmacist to a prescription drug purchaser who is a program participant under s. 49.689 of the amount of the discount on the retail price of the prescription drug that is provided to the participant as the result of the program under s. 49.689.

AB857,12,8 (End)