AB 557

This 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 insulin manufacturers establish a patient assistance

program to make insulin available to any qualifying Wisconsin resident who is

uninsured or has limited insurance coverage and whose income does not exceed 400

percent of the federal poverty guidelines. 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 issues

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 the Office

of the Commissioner of Insurance. 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

information about the number of patients served and amount of insulin dispensed

under the programs and that OCI annually report to 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 who

participate in the programs, and report to the legislature on the surveys by July 1,

2024. Additionally, the bill requires that OCI develop a training program for health