SB70,1609,2322 2. The penalties assessed under sub. (9) during the previous calendar year,
23including the name of the manufacturer and amount of the penalty.
SB70,1610,3 24(8) Additional responsibilities of commissioner. (a) Application form. The
25commissioner shall make the application form described in sub. (2) (c) 1. a. available

1on the office's website and shall make the form available to pharmacies and health
2care providers who prescribe or dispense insulin, hospital emergency departments,
3urgent care clinics, and community health clinics.
SB70,1610,64 (b) Public outreach. 1. The commissioner shall conduct public outreach to
5create awareness of the urgent need safety net programs and patient assistance
6programs.
SB70,1610,87 2. The commissioner shall develop and make available on the office's website
8an information sheet that contains all of the following information:
SB70,1610,109 a. A description of how to access insulin through an urgent need safety net
10program.
SB70,1610,1111 b. A description of how to access insulin through a patient assistance program.
SB70,1610,1312 c. Information on how to contact a navigator for assistance in accessing insulin
13through an urgent need safety net program or patient assistance program.
SB70,1610,1514 d. Information on how to contact the commissioner if a manufacturer
15determines that an individual is not eligible for a patient assistance program.
SB70,1610,1716 e. A notification that an individual may contact the commissioner for more
17information or assistance in accessing ongoing affordable insulin options.
SB70,1610,2418 (c) Navigators. The commissioner shall develop a training program to provide
19navigators with information and the resources necessary to assist individuals in
20accessing appropriate long-term insulin options. The commissioner shall compile
21a list of navigators that have completed the training program and are available to
22assist individuals in accessing affordable insulin coverage options. The list shall be
23made available on the office's website and to pharmacies and health care
24practitioners who dispense and prescribe insulin.
SB70,1611,6
1(d) Satisfaction surveys. 1. The commissioner shall develop and conduct a
2satisfaction survey of individuals who have accessed insulin through urgent need
3safety net programs and patient assistance programs. The survey shall ask whether
4the individual is still in need of a long-term solution for affordable insulin and shall
5include questions about the individual's satisfaction with all of the following, if
6applicable:
SB70,1611,77 a. Accessibility to urgent-need insulin.
SB70,1611,98 b. Adequacy of the information sheet and list of navigators received from the
9pharmacy.
SB70,1611,1010 c. Helpfulness of a navigator.
SB70,1611,1211 d. Ease of access in applying for a patient assistance program and receiving
12insulin from the pharmacy under the patient assistance program.
SB70,1611,1613 2. The commissioner shall develop and conduct a satisfaction survey of
14pharmacies that have dispensed insulin through urgent need safety net programs
15and patient assistance programs. The survey shall include questions about the
16pharmacy's satisfaction with all of the following, if applicable:
SB70,1611,1817 a. Timeliness of reimbursement from manufacturers for insulin dispensed by
18the pharmacy under urgent need safety net programs.
SB70,1611,1919 b. Ease in submitting insulin orders to manufacturers.
SB70,1611,2020 c. Timeliness of receiving insulin orders from manufacturers.
SB70,1611,2221 3. The commissioner may contract with a nonprofit entity to develop and
22conduct the surveys under subds. 1. and 2. and to evaluate the survey results.
SB70,1611,2523 4. No later than July 1, 2026, the commissioner shall submit to the governor
24and the chief clerk of each house of the legislature, for distribution to the legislature
25under s. 13.172 (2), a report on the results of the surveys under subds. 1. and 2.
SB70,1612,5
1(9) Penalty. A manufacturer that violates this section may be required to
2forfeit not more than $200,000 per month of violation, with the maximum forfeiture
3increasing to $400,000 per month if the manufacturer continues to be in violation
4after 6 months and increasing to $600,000 per month if the manufacturer continues
5to be in violation after one year.
SB70,3091 6Section 3091 . 632.869 of the statutes is created to read:
SB70,1612,8 7632.869 Reimbursement to federal drug pricing program participants.
8 (1) In this section:
SB70,1612,129 (a) “Covered entity” means an entity described in 42 USC 256b (a) (4) (A), (D),
10(E), (J), or (N) that participates in the federal drug pricing program under 42 USC
11256b
, a pharmacy of the entity, or a pharmacy contracted with the entity to dispense
12drugs purchased through the federal drug pricing program under 42 USC 256b.
SB70,1612,1313 (b) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
SB70,1612,15 14(2) No person, including a pharmacy benefit manager and 3rd-party payer,
15may do any of the following:
SB70,1612,1916 (a) Reimburse a covered entity for a drug that is subject to an agreement under
1742 USC 256b at a rate lower than that paid for the same drug to pharmacies that are
18not covered entities and have a similar prescription volume to that of the covered
19entity.
SB70,1612,2220 (b) Assess a covered entity any fee, charge back, or other adjustment on the
21basis of the covered entity's participation in the federal drug pricing program under
2242 USC 256b.
SB70,1612,25 23(3) The commissioner may promulgate rules to implement this section and to
24establish a minimum reimbursement rate for covered entities and any other entity
25described under 42 USC 256b (a) (4).
SB70,3092
1Section 3092. 632.87 (4) of the statutes is amended to read:
SB70,1613,62 632.87 (4) No policy, plan or contract may exclude coverage for diagnosis and
3treatment of a condition or complaint by a licensed dentist or dental therapist within
4the scope of the dentist's or dental therapist's license, if the policy, plan or contract
5covers diagnosis and treatment of the condition or complaint by another health care
6provider, as defined in s. 146.81 (1) (a) to (p).
SB70,3093 7Section 3093 . 632.87 (7) of the statutes is created to read:
SB70,1613,88 632.87 (7) (a) In this subsection:
SB70,1613,99 1. “Health care provider” has the meaning given in s. 146.81 (1) (a) to (hp).
SB70,1613,1010 2. “Qualified treatment trainee” has the meaning given in s. DHS 35.03 (17m).
SB70,1613,1511 (b) No policy, plan, or contract may exclude coverage for mental health or
12behavioral health treatment or services provided by a qualified treatment trainee
13within the scope of the qualified treatment trainee's education and training if the
14policy, plan, or contract covers the mental health or behavioral health treatment or
15services when provided by another health care provider.
SB70,3094 16Section 3094. 632.87 (8) of the statutes is created to read:
SB70,1613,1717 632.87 (8) (a) In this subsection:
SB70,1613,1818 1. “Health care provider” has the meaning given in s. 146.81 (1) (a) to (hp).
SB70,1613,2019 2. “Substance abuse counselor” means a substance abuse counselor certified
20under s. 440.88.
SB70,1613,2521 (b) No policy, plan, or contract may exclude coverage for alcoholism or other
22drug abuse treatment or services provided by a substance abuse counselor within the
23scope of the substance abuse counselor's education and training if the policy, plan,
24or contract covers the alcoholism or other drug abuse treatment or services when
25provided by another health care provider.
SB70,3095
1Section 3095. 632.871 of the statutes is created to read:
SB70,1614,2 2632.871 Telehealth services. (1) Definitions. In this section:
SB70,1614,33 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
SB70,1614,54 (b) “Self-insured health plan” means a self-insured health plan of the state or
5a county, city, village, town, or school district.
SB70,1614,116 (c) “Telehealth" means a practice of health care delivery, diagnosis,
7consultation, treatment, or transfer of medically relevant data by means of audio,
8video, or data communications that are used either during a patient visit or a
9consultation or are used to transfer medically relevant data about a patient.
10“Telehealth" does not include communications delivered solely by audio-only
11telephone, facsimile machine, or email unless specified otherwise by rule.
SB70,1614,18 12(2) Coverage denial prohibited. No disability insurance policy or self-insured
13health plan may deny coverage for a treatment or service provided through
14telehealth on the basis that the treatment or service is provided through telehealth
15if that treatment or service is covered by the disability insurance policy or
16self-insured health plan when provided in person. A disability insurance policy or
17self-insured health plan may limit coverage of treatments or services provided
18through telehealth to those treatments or services that are medically necessary.
SB70,1614,22 19(3) Certain limitations on telehealth prohibited. A disability insurance
20policy or self-insured health plan may not subject a treatment or service provided
21through telehealth for which coverage is required under sub. (2) to any of the
22following:
SB70,1614,2423 (a) Any greater deductible, copayment, or coinsurance amount than would be
24applicable if the treatment or service is provided in person.
SB70,1615,4
1(b) Any policy or calendar year or lifetime benefit limit or other maximum
2limitation that is not imposed on other treatments or services covered by the
3disability insurance policy or self-insured health plan that are not provided through
4telehealth.
SB70,1615,65 (c) Prior authorization requirements that are not required for the same
6treatment or service when provided in person.
SB70,1615,77 (d) Unique location requirements.
SB70,1615,12 8(4) Disclosure of coverage of certain telehealth services. A disability
9insurance policy or self-insured health plan that covers a telehealth treatment or
10service that has no equivalent in-person treatment or service, such as remote patient
11monitoring, shall specify in policy or plan materials the coverage of that telehealth
12treatment or service.
SB70,3096 13Section 3096 . 632.895 (6) (title) of the statutes is amended to read:
SB70,1615,1414 632.895 (6) (title) Equipment and supplies for treatment of diabetes; insulin.
SB70,3097 15Section 3097 . 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and
16amended to read:
SB70,1616,217 632.895 (6) (a) Every disability insurance policy which that provides coverage
18of expenses incurred for treatment of diabetes shall provide coverage for expenses
19incurred by the installation and use of an insulin infusion pump, coverage for all
20other equipment and supplies, including insulin or any other prescription
21medication, used in the treatment of diabetes, and coverage of diabetic
22self-management education programs. Coverage Except as provided in par. (b),
23coverage
required under this subsection shall be subject to the same exclusions,
24limitations, deductibles, and coinsurance provisions of the policy as other covered
25expenses, except that insulin infusion pump coverage may be limited to the purchase

1of one pump per year and the insurer may require the insured to use a pump for 30
2days before purchase.
SB70,3098 3Section 3098 . 632.895 (6) (b) of the statutes is created to read:
SB70,1616,44 632.895 (6) (b) 1. In this paragraph:
SB70,1616,65 a. “Cost sharing” means the total of any deductible, copayment, or coinsurance
6amounts imposed on a person covered under a policy or plan.
SB70,1616,77 b. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
SB70,1616,108 2. Every disability insurance policy and self-insured health plan that cover
9insulin and impose cost sharing on prescription drugs may not impose cost sharing
10on insulin in an amount that exceeds $35 for a one-month supply of insulin.
SB70,1616,1511 3. Nothing in this paragraph prohibits a disability insurance policy or
12self-insured health plan from imposing cost sharing on insulin in an amount less
13than the amount specified under subd. 2. Nothing in this paragraph requires a
14disability insurance policy or self-insured health plan to impose any cost sharing on
15insulin.
SB70,3099 16Section 3099 . 632.895 (8) (d) of the statutes is amended to read:
SB70,1616,2317 632.895 (8) (d) Coverage is required under this subsection despite whether the
18woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c), and
19(e), coverage under this subsection may only be subject to exclusions and limitations,
20including deductibles, copayments and restrictions on excessive charges, that are
21applied to other radiological examinations covered under the disability insurance
22policy. Coverage under this subsection may not be subject to any deductibles,
23copayments, or coinsurance.
SB70,3100 24Section 3100 . 632.895 (13m) of the statutes is created to read:
SB70,1617,2
1632.895 (13m) Preventive services. (a) In this section, “self-insured health
2plan” has the meaning given in s. 632.85 (1) (c).
SB70,1617,53 (b) Every disability insurance policy, except any disability insurance policy that
4is described in s. 632.745 (11) (b) 1. to 12., and every self-insured health plan shall
5provide coverage for all of the following preventive services:
SB70,1617,66 1. Mammography in accordance with sub. (8).
SB70,1617,87 2. Genetic breast cancer screening and counseling and preventive medication
8for adult women at high risk for breast cancer.
SB70,1617,109 3. Papanicolaou test for cancer screening for women 21 years of age or older
10with an intact cervix.
SB70,1617,1211 4. Human papillomavirus testing for women who have attained the age of 30
12years but have not attained the age of 66 years.
SB70,1617,1313 5. Colorectal cancer screening in accordance with sub. (16m).
SB70,1617,1614 6. Annual tomography for lung cancer screening for adults who have attained
15the age of 55 years but have not attained the age of 80 years and who have health
16histories demonstrating a risk for lung cancer.
SB70,1617,1817 7. Skin cancer screening for individuals who have attained the age of 10 years
18but have not attained the age of 22 years.
SB70,1617,2019 8. Counseling for skin cancer prevention for adults who have attained the age
20of 18 years but have not attained the age of 25 years.
SB70,1617,2221 9. Abdominal aortic aneurysm screening for men who have attained the age of
2265 years but have not attained the age of 75 years and who have ever smoked.
SB70,1617,2523 10. Hypertension screening for adults and blood pressure testing for adults, for
24children under the age of 3 years who are at high risk for hypertension, and for
25children 3 years of age or older.
SB70,1618,2
111. Lipid disorder screening for minors 2 years of age or older, adults 20 years
2of age or older at high risk for lipid disorders, and all men 35 years of age or older.
SB70,1618,53 12. Aspirin therapy for cardiovascular health for adults who have attained the
4age of 55 years but have not attained the age of 80 years and for men who have
5attained the age of 45 years but have not attained the age of 55 years.
SB70,1618,76 13. Behavioral counseling for cardiovascular health for adults who are
7overweight or obese and who have risk factors for cardiovascular disease.
SB70,1618,88 14. Type II diabetes screening for adults with elevated blood pressure.
SB70,1618,109 15. Depression screening for minors 11 years of age or older and for adults when
10follow-up supports are available.
SB70,1618,1211 16. Hepatitis B screening for minors at high risk for infection and adults at high
12risk for infection.
SB70,1618,1413 17. Hepatitis C screening for adults at high risk for infection and onetime
14hepatitis C screening for adults born in any year from 1945 to 1965.
SB70,1618,1815 18. Obesity screening and management for all minors and adults with a body
16mass index indicating obesity, counseling and behavioral interventions for obese
17minors who are 6 years of age or older, and referral for intervention for obesity for
18adults with a body mass index of 30 kilograms per square meter or higher.
SB70,1618,2019 19. Osteoporosis screening for all women 65 years of age or older and for women
20at high risk for osteoporosis under the age of 65 years.
SB70,1618,2121 20. Immunizations in accordance with sub. (14).
Loading...
Loading...