LRB-4266/1
TJD:cdc
2021 - 2022 LEGISLATURE
December 7, 2021 - Introduced by Representatives Subeck, S. Rodriguez, Conley,
Doyle, Hebl, Hesselbein, Ohnstad, Pope, Shankland, Sinicki, Snodgrass,
Tusler and Vruwink, cosponsored by Senators Ringhand, Agard,
Larson and
Smith. Referred to Committee on Health.
AB745,1,3
1An Act to renumber 632.866 (1) (a); and
to create 632.866 (1) (ag), 632.866 (1)
2(cm) and 632.866 (2m) of the statutes;
relating to: prohibiting step therapy
3protocols for certain cancer drugs.
Analysis by the Legislative Reference Bureau
This bill prohibits an insurer, pharmacy benefit manager, or utilization review
organization from requiring a step therapy protocol for a drug that is prescribed for
metastatic cancer or a cancer-associated condition and the use of the drug is
approved by the federal Food and Drug Administration, consistent with best
practices for the treatment of metastatic cancer or the cancer-associated condition,
and supported by peer-reviewed publications that are based on evidence-based
research. A step therapy protocol, as defined in current law, establishes a specific
sequence in which medically appropriate prescription drugs are covered by a policy
or plan. Current law requires insurers, pharmacy benefit managers, and utilization
review organizations to use clinical review criteria for establishing a step therapy
protocol that are based on clinical practice guidelines that meet certain specific
criteria and to provide access to a process to request an exception to the step therapy
protocol.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB745,1
1Section
1. 632.866 (1) (a) of the statutes is renumbered 632.866 (1) (ar).
AB745,2
2Section
2. 632.866 (1) (ag) of the statutes is created to read:
AB745,2,63
632.866
(1) (ag) “Cancer-associated condition” means any symptom or side
4effect that is associated with metastatic cancer or the treatment of metastatic cancer
5and that, in the judgment of a health care provider, further jeopardizes the health
6of a patient if left untreated.
AB745,3
7Section
3. 632.866 (1) (cm) of the statutes is created to read:
AB745,2,108
632.866
(1) (cm) “Metastatic cancer” means cancer that has spread from the
9primary or original site of the cancer to nearby tissues, lymph nodes, or other areas
10or parts of the body.
AB745,4
11Section
4. 632.866 (2m) of the statutes is created to read:
AB745,2,1512
632.866
(2m) Step therapy protocol prohibited. An insurer, pharmacy
13benefit manager, or utilization review organization may not require a step therapy
14protocol for a drug that is prescribed for metastatic cancer or a cancer-associated
15condition and the use of the drug is all of the following:
AB745,2,1616
(a) Approved by the federal food and drug administration.
AB745,2,1817
(b) Consistent with best practices for the treatment of metastatic cancer or the
18cancer-associated condition.
AB745,2,2019
(c) Supported by peer-reviewed publications that are based on evidence-based
20research.
