AB355: Bill Text

AB355,18,3 (c) An entity that enters into a contract with the department under this subsection, or a parent company or subsidiary of that entity, may not incur a financial interest in sales of a particular prescription drug during the term of the contract.

AB355,18,6 (d) The department shall periodically audit any entity with which it contracts under this subsection to determine whether the entity, its parent company, or a subsidiary has any financial interests that are prohibited under this subsection.

AB355, s. 14 Section 14. 49.692 of the statutes is created to read:

AB355,18,8 49.692 Prescription drug assistance. (1) In this section:

AB355,18,9 (a) "Labeler" has the meaning given in s. 49.69 (1) (d).

AB355,18,10 (b) "Manufacturer" has the meaning given in s. 49.69 (1) (f).

AB355,18,14 (c) "Participating pharmacy or pharmacist" means a person who is licensed as a pharmacy or pharmacist in any state and who agrees to sell prescription drugs to a person who has a prescription drug card issued under sub. (3) for the amount provided under sub. (5).

AB355,18,15 (d) "Prescription drug" has the meaning given in s. 450.01 (20).

AB355,18,16 (e) "Prescription order" has the meaning given in s. 450.01 (21).

AB355,18,17 (f) "State" has the meaning given in s. 441.50 (2) (m).

AB355,18,20 (2) (a) A person to whom all of the following applies is eligible to purchase prescription drugs from a participating pharmacy or pharmacist for the amount provided under sub. (5):

AB355,18,21 1. The person is a resident, as defined in s. 27.01 (10) (a), of this state.

AB355,19,2 2. The person is not a recipient of Medical Assistance, does not have health care coverage under s. 49.665, does not have a policy issued under ch. 149, is not enrolled in the program under s. 49.688, and does not have insurance coverage for prescription drugs for outpatient care, except that a person who receives benefits under 42 USC 1395 to 1395ccc may have supplemental health insurance that covers prescription drugs for outpatient care.

AB355,19,5 (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.

AB355,19,10 (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 for each 12-month benefit period, shall issue to eligible persons a prescription drug card for use in purchasing prescription drugs, as provided under this section.

AB355,19,12 (4) The department shall set maximum prices and a maximum dispensing fee for prescription drugs purchased under this section.

AB355,19,18 (5) Beginning September 1, 2004, a participating pharmacy or pharmacist may not charge a person who presents a valid prescription order and a prescription drug card issued under sub. (3) more than the maximum price established by the department under sub. (4) for a prescription drug, less any rebate amount agreed to under s. 49.69 (6) (a) 1., plus the maximum dispensing fee established by the department under sub. (4).

AB355,19,23 (6) From the appropriation account under s. 20.435 (4) (jx) and (8) (mb), the department shall reimburse participating pharmacies and pharmacists the applicable rebate amounts specified in agreements under s. 49.69 (6) (a) 1., if any, for each prescription drug that the pharmacy or pharmacist sells to a person who has a prescription drug card issued under sub. (3).

AB355,19,24 (7) The department shall promulgate rules establishing the following:

AB355,20,2 (a) The method for determining the maximum retail price for a prescription drug.

AB355,20,3 (b) The method for determining the maximum dispensing fee.

AB355,20,5 (c) The method for informing participating pharmacies and pharmacists of the maximum prices, dispensing fees, and rebate amounts for prescription drugs.

AB355,20,7 (d) The process by which a participating pharmacy or pharmacist may claim reimbursement for rebates.

AB355,20,10 (e) The process for resolving discrepancies between the rebate amount claimed by a participating pharmacy or pharmacist and the amount paid by a manufacturer or labeler.

AB355, s. 15 Section 15 . 49.692 (6) of the statutes, as created by 2003 Wisconsin Act .... (this act), is amended to read:

AB355,20,17 49.692 (6) From the appropriation account under s. 20.435 (4) (jx) and (8) (mb), the department shall reimburse participating pharmacies and pharmacists the applicable rebate amounts specified in agreements under s. 49.69 (6) (a) 1., if any, for each prescription drug that the pharmacy or pharmacist sells to a person who has a prescription drug card issued under sub. (3).

AB355, s. 16 Section 16. 146.93 (1) (a) of the statutes is amended to read:

AB355,20,23 146.93 (1) (a) From the appropriation appropriation accounts under s. 20.435 (4) (gp) and (jx), the department shall maintain a program for the provision of primary health care services based on the primary health care program in existence on June 30, 1987. The department may promulgate rules necessary to implement the program.

AB355, s. 17 Section 17. 149.14 (4c) (c) of the statutes is created to read:

AB355,21,7 149.14 (4c) (c) The department or an entity with which the department contracts shall provide to a drug manufacturer that sells drugs for prescribed use in this state documents designed for use by the manufacturer in entering into a rebate agreement with the department or entity that is modeled on the rebate agreement specified under 42 USC 1396r-8. The department or entity may enter into a rebate agreement under this paragraph that shall include all of the following as requirements:

AB355,21,14 1. That, as a condition of coverage for prescription drugs of a manufacturer under this section other than prescription drugs that are prescribed for the treatment of acquired immunodeficiency syndrome or human immunodeficiency virus, the manufacturer shall make rebate payments for each prescription drug of the manufacturer, that is prescribed for and purchased by an eligible person, to the state treasurer to be credited to the appropriation account under s. 20.435 (4) (jh), each calendar quarter or according to a schedule established by the department.

AB355,21,16 2. That the amount of the rebate payment shall be determined by a method specified in 42 USC 1396r-8 (c).

AB355, s. 18 Section 18. 149.143 (1) (a) of the statutes is amended to read:

AB355,21,20 149.143 (1) (a) First from the moneys transferred to the fund from the appropriation account under s. 20.435 (4) (af) and from the moneys appropriated for the health insurance risk-sharing plan under s. 20.435 (4) (jh) and (jx).

AB355, s. 19 Section 19. 441.16 (7) of the statutes is created to read:

AB355,22,7 441.16 (7) Upon the request of the department of health and family services, the board shall investigate an advanced practice nurse to determine whether the advanced practice nurse routinely prescribes prescription drugs that are not on the applicable preferred drug list established under s. 49.69 to beneficiaries of state-supported health care assistance programs, as defined in s. 49.69 (1) (m), or to persons enrolled in the prescription drug assistance program under s. 49.692, without medical justification. If the board determines that an advanced practice nurse routinely prescribes drugs that are not on the applicable preferred drug list without medical justification, the board shall require the advanced practice nurse to complete the preferred drug list education program under s. 448.075 (2) at the earliest possible opportunity.

AB355, s. 20 Section 20. 447.08 of the statutes is created to read:

AB355,22,18 447.08 Preferred drug list compliance. Upon the request of the department of health and family services, the board shall investigate a dentist to determine whether the dentist routinely prescribes prescription drugs that are not on the applicable preferred drug list established under s. 49.69 to beneficiaries of state-supported health care assistance programs, as defined in s. 49.69 (1) (m), or to persons enrolled in the Prescription Drug Assistance Program under s. 49.692, without medical justification. If the board determines that a dentist routinely prescribes drugs that are not on the applicable preferred drug list without medical justification, the board shall require the dentist to complete the preferred drug list education program under s. 448.075 (2) at the earliest possible opportunity.

AB355, s. 21 Section 21. 448.075 of the statutes is created to read:

AB355,23,6 448.075 Preferred drug list compliance. (1) Upon the request of the department of health and family services, the board shall investigate a physician or physician assistant to determine whether the physician or physician assistant routinely prescribes prescription drugs that are not on the applicable preferred drug list established under s. 49.69 to beneficiaries of state-supported health care assistance programs, as defined in s. 49.69 (1) (m), or to persons enrolled in the Prescription Drug Assistance Program under s. 49.692, without medical justification. If the board determines that a physician or physician assistant routinely prescribes drugs that are not on the applicable preferred drug list without medical justification, the board shall require the physician or physician assistant to complete the preferred drug list education program under sub. (2) at the earliest possible opportunity.

AB355,23,16 (2) The department of regulation and licensing shall develop an education program on the preferred drug lists created under s. 49.69 for practitioners, as defined in s. 450.01 (17). The department of regulation and licensing shall consult with the department of health and family services in developing the education program and shall present the education program both as a class and in visits to practitioners' offices. The department of regulation and licensing shall charge practitioners who are required under sub. (1) or s. 441.16 (7) or 447.08 to participate in the education program to pay a fee to cover the cost of the class or office visit. All fees collected under this subsection shall be credited to the appropriation account under s. 20.435 (4) (jt).

AB355, s. 22 Section 22. 450.02 (2) of the statutes is renumbered 450.02 (2) (intro.) and amended to read:

AB355,23,20 450.02 (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:

AB355,23,22 (a) Defining the active practice of pharmacy. The rules shall apply to all applicants for licensure under s. 450.05.

AB355, s. 23 Section 23. 450.02 (2) (b) of the statutes is created to read:

AB355,24,2 450.02 (2) (b) Requiring disclosure by a pharmacist to a prescription drug purchaser who has a card issued under s. 49.692 (3) of the amount of the discount on the retail price of the prescription drug that is provided to the purchaser as a result of the program under s. 49.692.

AB355, s. 24 Section 24. 450.075 of the statutes is created to read:

AB355,24,4 450.075 Manufacturer gift reporting. (1) In this section:

AB355,24,5 (a) "Health benefit plan" has the meaning given in s. 632.745 (11).

AB355,24,6 (b) "Hospital" means a facility approved as a hospital under s. 50.35.

AB355,24,7 (c) "Nursing home" has the meaning given in s. 50.01 (3).

AB355,24,12 (2) (a) Except as provided in par. (c), each person who engages in manufacturing shall annually report to the board the value, nature, and purpose of any gift, payment, subsidy, or other economic benefit valued at $25 or more that the person directly or indirectly provides to any of the following in connection with the person's promotional or marketing activities:

AB355,24,13 1. A practitioner.

AB355,24,14 2. A pharmacist or an owner or operator of a pharmacy.

AB355,24,17 3. A hospital, nursing home, or organization that offers a health benefit plan, or an employee of a hospital, nursing home, or organization that offers a health benefit plan.

AB355,24,19 4. Any other person authorized to purchase prescription drugs for retail or wholesale resale.

AB355,24,22 (b) A person who engages in manufacturing shall submit the report required under par. (a) by January 1 of each year for the 12-month period ending on the previous June 30.

AB355,24,25 (c) A person who engages in manufacturing is not required to report under par. (a) any free sample of a prescription drug that is intended to be distributed to a patient.

AB355,25,4 (3) Each person who engages in manufacturing shall report to the board the name and address of the individual responsible for making reports under sub. (2) and shall notify the board of any change in the information required under this subsection.

AB355,25,8 (4) A person who engages in manufacturing who violates sub. (2) may be required to forfeit not more than $10,000 for each violation and, notwithstanding s. 814.04, to pay all actual costs incurred by the state in prosecuting the violation, including reasonable attorney fees.

AB355,25,10 (5) The board shall develop a form that persons who engage in manufacturing shall use to submit reports under sub. (2).

AB355,25,16 (6) Any information reported under this section that constitutes a trade secret, as defined in s. 134.90 (1) (c), shall remain confidential. The board may not release trade secret information obtained under this section, except to the department of justice for the purpose of prosecuting a violation under sub. (4). The form prescribed by the board under sub. (5) shall direct a person who engages in manufacturing to identify any information that is a trade secret.

AB355,25,19 (7) Annually, by March 1, the board shall submit to the legislature under s. 13.172 (2) and to the governor a report describing the disclosures made under sub. (2).

AB355, s. 25 Section 25 . Nonstatutory provisions.

AB355,26,2 (1) Enrollment fee for prescription drug assistance program. The enrollment fee for the prescription drug assistance program under section 49.692 (3) of the statutes, as created by this act, shall be $20, except that the department of health and family services shall review the costs to administer the prescription drug assistance program after it has been implemented for 12 months and shall reduce the program enrollment fee if the earnings from the fee are greater than the costs incurred by the department in administering the program.

AB355,26,8 (2) Report to legislature. By July 1, 2006, the department of health and family services shall report to the appropriate standing committees of the legislature, in the manner provided under section 13.172 (3) of the statutes, on the creation of preferred drug lists, the status of supplemental prescription drug rebate agreements, and the implementation of prescription drug cost controls under section 49.69 of the statutes, as created by this act.

AB355,27,6 (3) Use of income augmentation receipts for initial reimbursement to pharmacists and pharmacies. If after supporting the costs specified in section 46.46 of the statutes, there remain any moneys in the appropriation account under section 20.435 (8) (mb) of the statutes, as affected by this act, those remaining moneys are allocated to the department of health and family services to reimburse pharmacies and pharmacists under section 49.692 (6) of the statutes, as created by this act, until such time as there is enough money in the account under section 20.435 (4) (jx) of the statutes, as created by this act, to make timely reimbursement payments to pharmacies and pharmacists under section 49.692 (6) (a) of the statutes, as created by this act. The department of health and family services may not expend or encumber any moneys allocated under this subsection unless the department submits a plan for the proposed use of those moneys to the secretary of administration. If the secretary of administration approves the plan, he or she shall submit the plan to the joint committee on finance. If the cochairpersons of the committee do not notify the secretary of administration within 14 working days after the date of the secretary's submittal of the plan that the committee has scheduled a meeting for the purpose of reviewing the plan, the department of health and family services may implement the plan as proposed by the department of health and family services and approved by the secretary of administration. If, within 14 working days after the date of the secretary's submittal, the cochairpersons of the committee notify the secretary that the committee has scheduled a meeting for the purpose of reviewing the plan, the department of health and family services may implement the plan only upon the approval of the committee.

AB355,27,16 (4) Emergency rules. The department of health and family services shall, using the procedure under section 227.24 of the statutes, promulgate the rules required under section 49.692 (7) of the statutes, as created by this act, for the period before permanent rules become effective, but not to exceed the period authorized under section 227.24 (1) (c) and (2) of the statutes. Notwithstanding section 227.24 (1) (a), (2) (b), and (3) of the statutes, the department is not required to provide evidence that promulgating a rule under this subsection as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this subsection.

AB355, s. 26 Section 26. Effective dates. This act takes effect on the day after publication, on the 2nd day after publication of the 2003-05 biennial budget act, or on July 1, 2003, whichever is later, except as follows:

AB355,27,21 (1) The treatment of sections 20.435 (8) (mb) (by Section 6 ) and 49.692 (6) (by Section 15) of the statutes takes effect on July 1, 2005.

AB355,27,22 (End)