Insulin safety net programs
The bill requires insulin manufacturers to establish a program under which
qualifying Wisconsin residents who are in urgent need of insulin and are uninsured
or have limited insurance coverage can be dispensed insulin at a pharmacy. Under
the program, if a qualifying individual in urgent need of insulin provides a pharmacy
with a form attesting that the individual meets the program's eligibility
requirements, specified proof of residency, and a valid insulin prescription, the
pharmacy must dispense a 30-day supply of insulin to the individual and may charge
the individual a copayment of no more than $35. The pharmacy may submit an
electronic payment claim for the insulin's acquisition cost to the manufacturer or
agree to receive a replacement of the same insulin in the amount dispensed.
The bill also requires that each insulin manufacturer establish a patient
assistance program to make insulin available to any qualifying Wisconsin resident
who, among other requirements, is uninsured or has limited insurance coverage and
whose family income does not exceed 400 percent of the federal poverty line. Under
the bill, an individual must apply to participate in a manufacturer's program. If the
manufacturer determines that the individual meets the program's eligibility
requirements, the manufacturer must issue the individual a statement of eligibility,
which is valid for 12 months and may be renewed. Under the bill, if an individual
with a statement of eligibility and valid insulin prescription requests insulin from
a pharmacy, the pharmacy must submit an order to the manufacturer, who must then
provide a 90-day supply of insulin at no charge to the individual or pharmacy. The
pharmacy may charge the individual a copayment of no more than $50. Under the
bill, a manufacturer is not required to issue a statement of eligibility if the individual
has prescription drug coverage through an individual or group health plan and the
manufacturer determines that the individual's insulin needs are better addressed
through the manufacturer's copayment assistance program. In such case, the
manufacturer must provide the individual with the necessary drug coupons, and the
individual may not be required to pay more than a $50 copayment for a 90-day
supply of insulin.
Under the bill, if the manufacturer determines that an individual is not eligible
for the patient assistance program, the individual may file an appeal with OCI. The
bill directs OCI to establish procedures for deciding appeals. Under the bill, OCI
must issue a decision within 10 days, and that decision is final.
The bill requires that insulin manufacturers annually report to OCI certain
information, including the number of individuals served and the cost of insulin
dispensed under the programs and that OCI annually report to the governor and the
legislature on the programs. The bill also directs OCI to conduct public outreach and
develop an information sheet about the programs, conduct satisfaction surveys of
individuals and pharmacies that participate in the programs, and report to the
governor and the legislature on the surveys by July 1, 2026. Additionally, the bill
requires that OCI develop a training program for health care navigators to assist
individuals in accessing appropriate long-term insulin options and maintain a list
of trained navigators.

The bill provides that a manufacturer that fails to comply with the bill's
provisions may be assessed a penalty of up to $200,000 per month of noncompliance,
which increases to $400,000 per month if the manufacturer continues to be in
noncompliance after six months and to $600,000 per month if the manufacturer
continues to be in noncompliance after one year. The bill's requirements do not apply
to manufacturers with annual insulin sales revenue in Wisconsin of no more than
$2,000,000 or to insulin that costs less than a specified dollar amount.
This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.
Because this bill creates a new crime or revises a penalty for an existing crime,
the Joint Review Committee on Criminal Penalties may be requested to prepare a
report.
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:
AB748,1 1Section 1 . 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
2the following amounts for the purposes indicated: - See PDF for table PDF
AB748,2 3Section 2 . 20.145 (1) (a) of the statutes is created to read:
AB748,7,54 20.145 (1) (a) State operations. The amounts in the schedule for general
5program operations.
AB748,3 6Section 3 . 49.45 (18) (ac) of the statutes is amended to read:
AB748,8,97 49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag),
8any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the
9benefits under s. 49.46 (2) (a) and (b) under s. 49.471, shall pay up to the maximum

1amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided
2under s. 49.46 (2). The service provider shall collect the specified or allowable
3copayment, coinsurance, or deductible, unless the service provider determines that
4the cost of collecting the copayment, coinsurance, or deductible exceeds the amount
5to be collected. The department shall reduce payments to each provider by the
6amount of the specified or allowable copayment, coinsurance, or deductible. No
7provider may deny care or services because the recipient is unable to share costs, but
8an inability to share costs specified in this subsection does not relieve the recipient
9of liability for these costs.
AB748,4 10Section 4 . 49.45 (18) (ag) of the statutes is repealed.
AB748,5 11Section 5 . 49.45 (18) (b) 8. of the statutes is created to read:
AB748,8,1212 49.45 (18) (b) 8. Prescription drugs.
AB748,6 13Section 6 . 255.056 (2g) of the statutes is created to read:
AB748,8,1914 255.056 (2g) The department may partner with out-of-state drug repository
15programs. The department may authorize a medical facility or pharmacy that elects
16to participate in the drug repository program to receive drugs or supplies from out
17of state, and the department may authorize an out-of-state entity that participates
18in a partner out-of-state drug repository program to receive drugs or supplies from
19Wisconsin.
AB748,7 20Section 7 . 450.085 (3) of the statutes is created to read:
AB748,8,2321 450.085 (3) An applicant for renewal of a license under s. 450.08 (2) (a) may
22count, for purposes of the continuing education requirement under sub. (1), up to 10
23hours spent as a volunteer at a free and charitable clinic approved by the board.
AB748,8 24Section 8 . 601.31 (1) (nv) of the statutes is created to read:
AB748,9,2
1601.31 (1) (nv) For issuing or renewing a license as a pharmaceutical
2representative under s. 632.863, an amount to be set by the commissioner by rule.
AB748,9 3Section 9 . 601.31 (1) (nw) of the statutes is created to read:
AB748,9,64 601.31 (1) (nw) For issuing or renewing a license as a pharmacy services
5administrative organization under s. 632.864, an amount to be set by the
6commissioner by rule.
AB748,10 7Section 10 . 601.41 (13) of the statutes is created to read:
AB748,9,138 601.41 (13) Value-based diabetes medication pilot project. The
9commissioner shall develop a pilot project to direct a pharmacy benefit manager, as
10defined in s. 632.865 (1) (c), and a pharmaceutical manufacturer to create a
11value-based, sole-source arrangement to reduce the costs of prescription medication
12used to treat diabetes. The commissioner may promulgate rules to implement this
13subsection.
AB748,11 14Section 11 . 601.415 (14) of the statutes is created to read:
AB748,9,2015 601.415 (14) Patient pharmacy benefits tool. (a) From the appropriation
16under s. 20.145 (1) (a), beginning in the 2024-25 fiscal year, the office shall award
17grants in a total amount of up to $500,000 each fiscal year to health care providers
18to develop and implement a tool for prescribers to disclose the cost of prescription
19drugs for patients. The tool must be usable by physicians and other prescribers to
20determine the cost of prescription drugs for their patients.
AB748,9,2221 (b) Any health care provider that receives a grant under par. (a) shall contribute
22matching funds equal to at least 50 percent of the grant amount awarded.
AB748,12 23Section 12 . 601.575 of the statutes is created to read:
AB748,9,25 24601.575 Prescription drug importation program. (1) Importation
25program requirements.
The commissioner, in consultation with persons interested

1in the sale and pricing of prescription drugs and appropriate officials and agencies
2of the federal government, shall design and implement a prescription drug
3importation program for the benefit of residents of this state, that generates savings
4for residents, and that satisfies all of the following:
AB748,10,75 (a) The commissioner shall designate a state agency to become a licensed
6wholesale distributor or to contract with a licensed wholesale distributor and shall
7seek federal certification and approval to import prescription drugs.
AB748,10,98(b) The program shall comply with relevant requirements of 21 USC 384,
9including safety and cost savings requirements.
AB748,10,1110 (c) The program shall import prescription drugs from Canadian suppliers
11regulated under any appropriate Canadian or provincial laws.
AB748,10,1312 (d) The program shall have a process to sample the purity, chemical
13composition, and potency of imported prescription drugs.
AB748,10,1714 (e) The program shall import only those prescription drugs for which
15importation creates substantial savings for residents of this state and only those
16prescription drugs that are not brand-name drugs and that have fewer than 4
17competitor prescription drugs in the United States.
AB748,10,1918 (f) The commissioner shall ensure that prescription drugs imported under the
19program are not distributed, dispensed, or sold outside of this state.
AB748,10,2020 (g) The program shall ensure all of the following:
AB748,10,2221 1. Participation by any pharmacy or health care provider in the program is
22voluntary.
AB748,10,2423 2. Any pharmacy or health care provider participating in the program has the
24appropriate license or other credential in this state.
AB748,11,3
13. Any pharmacy or health care provider participating in the program charges
2a consumer or health plan the actual acquisition cost of the imported prescription
3drug that is dispensed.
AB748,11,74 (h) The program shall ensure that a payment by a health plan or health
5insurance policy for a prescription drug imported under the program reimburses no
6more than the actual acquisition cost of the imported prescription drug that is
7dispensed.
AB748,11,98 (i) The program shall ensure that any health plan or health insurance policy
9participating in the program does all of the following:
AB748,11,1110 1. Maintains a formulary and claims payment system with current information
11on prescription drugs imported under the program.
AB748,11,1412 2. Bases cost-sharing amounts for participants or insureds under the plan or
13policy on no more than the actual acquisition cost of the prescription drug imported
14under the program that is dispensed to the participant or insured.
AB748,11,1715 3. Demonstrates to the commissioner or a state agency designated by the
16commissioner how premiums under the plan or policy are affected by savings on
17prescription drugs imported under the program.
AB748,11,2018 (j) Any wholesale distributor importing prescription drugs under the program
19shall limit its profit margin to the amount established by the commissioner or a state
20agency designated by the commissioner.
AB748,11,2221 (k) The program may not import any generic prescription drug that would
22violate federal patent laws on branded products in the United States.
AB748,12,223(L) The program shall comply with tracking and tracing requirements of 21
24USC 360eee
and 360eee-1, to the extent practical and feasible, before the
25prescription drug to be imported comes into the possession of this state's wholesale

1distributor and fully after the prescription drug to be imported is in the possession
2of this state's wholesale distributor.
AB748,12,43 (m) The program shall establish a fee or other mechanism to finance the
4program that does not jeopardize significant savings to residents of this state.
AB748,12,55 (n) The program shall have an audit function that ensures all of the following:
AB748,12,76 1. The commissioner has a sound methodology to determine the most
7cost-effective prescription drugs to include in the program.
AB748,12,98 2. The commissioner has a process in place to select Canadian suppliers that
9are high quality, high performing, and in full compliance with Canadian laws.
AB748,12,1110 3. Prescription drugs imported under the program are pure, unadulterated,
11potent, and safe.
AB748,12,1212 4. The program is complying with the requirements of this subsection.
AB748,12,1413 5. The program is adequately financed to support administrative functions of
14the program while generating significant cost savings to residents of this state.
AB748,12,1615 6. The program does not put residents of this state at a higher risk than if the
16program did not exist.
AB748,12,1817 7. The program provides and is projected to continue to provide substantial cost
18savings to residents of this state.
AB748,12,21 19(2) Anticompetitive behavior. The commissioner, in consultation with the
20attorney general, shall identify the potential for and monitor anticompetitive
21behavior in industries affected by a prescription drug importation program.
AB748,13,6 22(3) Approval of program design; certification. No later than the first day of
23the 7th month beginning after the effective date of this subsection .... [LRB inserts
24date], the commissioner shall submit to the joint committee on finance a report that
25includes the design of the prescription drug importation program in accordance with

1this section. The commissioner may not submit the proposed program to the federal
2department of health and human services unless the joint committee on finance
3approves the proposed program. Within 14 days of the date of approval by the joint
4committee on finance of the proposed program, the commissioner shall submit to the
5federal department of health and human services a request for certification of the
6approved program.
AB748,13,14 7(4) Implementation of certified program. After the federal department of
8health and human services certifies the prescription drug importation program
9submitted under sub. (3), the commissioner shall begin implementation of the
10program, and the program shall be fully operational by 180 days after the date of
11certification by the federal department of health and human services. The
12commissioner shall do all of the following to implement the program to the extent the
13action is in accordance with other state laws and the certification by the federal
14department of health and human services:
AB748,13,1715 (a) Become a licensed wholesale distributor, designate another state agency to
16become a licensed wholesale distributor, or contract with a licensed wholesale
17distributor.
AB748,13,1918 (b) Contract with one or more Canadian suppliers that meet the criteria in sub.
19(1) (c) and (n).
AB748,13,2220 (c) Create an outreach and marketing plan to communicate with and provide
21information to health plans and health insurance policies, employers, pharmacies,
22health care providers, and residents of this state on participating in the program.
AB748,13,2523 (d) Develop and implement a registration process for health plans and health
24insurance policies, pharmacies, and health care providers interested in participating
25in the program.
AB748,14,2
1(e) Create a publicly accessible source for listing prices of prescription drugs
2imported under the program.
AB748,14,53 (f) Create, publicize, and implement a method of communication to promptly
4answer questions from and address the needs of persons affected by the
5implementation of the program before the program is fully operational.
AB748,14,76 (g) Establish the audit functions under sub. (1) (n) with a timeline to complete
7each audit function every 2 years.
AB748,14,98 (h) Conduct any other activities determined by the commissioner to be
9important to successful implementation of the program.
AB748,14,11 10(5) Report. By January 1 and July 1 of each year, the commissioner shall
11submit to the joint committee on finance a report including all of the following:
AB748,14,1312 (a) A list of prescription drugs included in the prescription drug importation
13program under this section.
AB748,14,1614 (b) The number of pharmacies, health care providers, and health plans and
15health insurance policies participating in the prescription drug importation program
16under this section.
AB748,14,2117 (c) The estimated amount of savings to residents of this state, health plans and
18health insurance policies, and employers resulting from the implementation of the
19prescription drug importation program under this section reported from the date of
20the previous report under this subsection and from the date the program was fully
21operational.
AB748,14,2322 (d) Findings of any audit functions under sub. (1) (n) completed since the date
23of the previous report under this subsection.
AB748,14,25 24(6) Rulemaking. The commissioner may promulgate any rules necessary to
25implement this section.
AB748,13
1Section 13 . 609.83 of the statutes is amended to read:
AB748,15,4 2609.83 Coverage of drugs and devices. Limited service health
3organizations, preferred provider plans, and defined network plans are subject to ss.
4632.853, 632.861, and 632.895 (6) (b), (16t), and (16v).
AB748,14 5Section 14 . 632.863 of the statutes is created to read:
AB748,15,6 6632.863 Pharmaceutical representatives. (1) Definitions. In this section:
AB748,15,97 (a) “Health care professional” means a physician or other health care
8practitioner who is licensed to provide health care services or to prescribe
9pharmaceutical or biologic products.
AB748,15,1110 (b) “Pharmaceutical” means a medication that may legally be dispensed only
11with a valid prescription from a health care professional.
AB748,15,1412 (c) “Pharmaceutical representative” means an individual who markets or
13promotes pharmaceuticals to health care professionals on behalf of a pharmaceutical
14manufacturer for compensation.
AB748,15,1815 (d) “Wholesale acquisition cost” means the most recently reported
16manufacturer list or catalog price for a brand-name or generic drug available to
17wholesalers or direct purchasers in the United States, before application of
18discounts, rebates, or reductions in price.
AB748,15,24 19(2) Licensure. (a) No individual may act as a pharmaceutical representative
20in this state without being licensed by the commissioner as a pharmaceutical
21representative under this section. In order to obtain a license, the individual shall
22apply to the commissioner in the form and manner prescribed by the commissioner.
23The term of a license issued under this paragraph is one year and is renewable. The
24application to obtain or renew a license shall include all of the following information:
AB748,16,2
11. The applicant's full name, residence address and telephone number, and
2business address and telephone number.
Loading...
Loading...