LRB-4976/1
JPC:skw&amn
2023 - 2024 LEGISLATURE
November 9, 2023 - Introduced by Representatives Novak, Dittrich and Donovan,
cosponsored by Senators James, Ballweg, Cabral-Guevara and Quinn.
Referred to Committee on Health, Aging and Long-Term Care.
AB654,1,3
1An Act to create 49.45 (9o) of the statutes;
relating to: utilization management
2controls for prescription drugs to treat mental illness under the Medical
3Assistance program.
Analysis by the Legislative Reference Bureau
This bill prohibits the Department of Health Services from imposing any
utilization management controls for prescription drugs under the Medical
Assistance program that are approved by the federal Food and Drug Administration
and have an indication of approval from the federal Food and Drug Administration
for the treatment of a serious mental illness. Under the bill, “serious mental illness”
is defined to mean a mental disorder, as defined in the most recent edition of the
Diagnostic and Statistical Manual of Mental Disorders published by the American
Psychiatric Association, such as bipolar disorder, schizophrenia or schizotypal
disorder, major depressive disorder, or post-traumatic stress disorder, that results
in serious functional impairment that substantially interferes with or limits one or
more major life activities. 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.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB654,1
1Section
1. 49.45 (9o) of the statutes is created to read:
AB654,2,32
49.45
(9o) Utilization management controls for prescription drugs to treat
3mental illness. (a) In this subsection:
AB654,2,44
1. “Prescription drug” has the meaning given in s. 450.01 (20).
AB654,2,105
2. “Serious mental illness” means a mental disorder, as defined in the most
6recent edition of the Diagnostic and Statistical Manual of Mental Disorders
7published by the American Psychiatric Association, such as bipolar disorder,
8schizophrenia or schizotypal disorder, major depressive disorder, or post-traumatic
9stress disorder, that results in serious functional impairment that substantially
10interferes with or limits one or more major life activities.
AB654,2,1411
3. “Utilization management controls” means a set of formal techniques used by
12a health carrier or prescription drug utilization management entity that are
13designed to evaluate prescription drug medical necessity, appropriateness, efficacy,
14or efficiency, including prior authorization and step therapy protocols.
AB654,2,1815
(b) The department may not impose utilization management controls for any
16prescription drug that is approved by the federal food and drug administration and
17has an indication of approval from the federal food and drug administration for the
18treatment of a serious mental illness.
