SB 540

This bill creates a prescription drug affordability review board, whose purpose

is to protect Wisconsin residents and other stakeholders from the high costs of

prescription drugs. The board consists of the commissioner of insurance and the

following members, all of whom are appointed by the governor for four-year terms:

1. Two members who represent the pharmaceutical drug industry, at least one

of whom is a licensed pharmacist.

2. Two members who represent the health insurance industry.

3. Two members who represent the health care industry, at least one of whom

is a licensed practitioner.

4. Two members who represent the interests of the public.

The bill requires the board to meet in open session at least four times per year

to review prescription drug pricing information. The board must provide at least two

weeks' public notice of its meetings, make the meeting's materials publicly available

at least one week prior to meeting, and provide the opportunity for public comment.

The bill imposes conflict of interest requirements for the board relating to recusal

and public disclosure of certain conflicts. The bill directs the board to access and

assess drug pricing information, to the extent practicable, by accessing and assessing

information from other states, by assessing spending for the drug in Wisconsin, and

by accessing other available pricing information.

Under the bill, the board must conduct drug cost affordability reviews. The first

step in the reviews is for the board to identify prescription drugs whose increase in

wholesale acquisition cost exceeds specified thresholds and other prescription drugs

that may create affordability challenges for the health care system in Wisconsin. For

each identified prescription drug, the board must determine whether to conduct an

affordability review by seeking stakeholder input and considering the average

patient cost share for the drug. During an affordability review, the board must

determine whether use of the prescription drug that is fully consistent with the

labeling approved by the federal Food and Drug Administration or standard medical

practice has led or will lead to an affordability challenge for the health care system

in Wisconsin. In making this determination, the bill requires the board to consider

a variety of factors, which include the following:

1. The drug's wholesale acquisition cost.

2. The average monetary price concession, discount, or rebate the

manufacturer provides, or is expected to provide, for the drug to health plans.

3. The total amount of price concessions, discounts, and rebates the

manufacturer provides to each pharmacy benefit manager for the drug.

4. The price at which therapeutic alternatives have been sold and the average

monetary concession, discount, or rebate the manufacturer provides, or is expected

to provide, to health plan payors and pharmacy benefit managers for therapeutic

alternatives.