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Wisconsin Legislative Movement Entries


Wisconsin S.B. 482


Rx Pricing; Reimbursements


Last Action:

(Died) MARCH  20, 2002; Failed to pass pursuant to Senate Joint Resolution 1.



Requires pharmacies and pharmacists, as a condition of medical assistance participation, to charge persons for prescription drugs no more than specific amounts; specifying requirements for rebate agreements between the department of health and family services and drug manufacturers or labelers; expandes prior authorization requirements under medical assistance; requires the exercise of rule- making authority; makes appropriations; provides penalties.


Synopsis Additional:

This bill provides that, beginning May 1, 2003, persons who have applied for  and have been found by DHFS to be eligible for prescription  drug  assistance and who have paid an enrollment fee of $ 20 for a 12-month benefit period may use a  card,  issued by DHFS, to obtain certain prescription  drugs  for outpatient care at a rate that is the average wholesale  price  minus 11.25% or  the maximum allowable cost, as determined by DHFS, whichever is less, plus a  pharmacy  dispensing fee that is not less than the dispensing fee paid under MA, but a  pharmacy  or pharmacist may not charge an amount that exceeds the usual and customary charge for the prescription  drug.  After November 30, 2003, an eligible person may use the prescription  drug card  to obtain prescription  drugs  by paying this rate, plus the dispensing fee, minus the amount of any rebate amount received by DHFS under rebate agreements with drug manufacturers and repackagers of the drugs (labelers). In determining the amounts discounted by the rebate, DHFS must consider an average of all rebate  payments  made under the program, as weighted by the sales of prescription  drugs  subject to the rebates over the most recent 12-month period for which the information is available. The  pharmacy or pharmacist  who sells the  drug  at these reduced  prices  receives reimbursement for the rebate amount from DHFS. Persons who are eligible to obtain prescription  drugs  for these reduced charges are state residents who have not had private health insurance coverage for outpatient prescription  drugs  for at least 30 consecutive days immediately prior to applying for the program, are not MA recipients, are not enrolled in Badger Care or the prescription drug assistance program for elderly persons (commonly known  as Senior Care), and do not have a policy issued under the health insurance risk-sharing plan (HIRSP). The $ 20 enrollment fee paid by eligible persons is required to be used for administration of the program.


Under the bill, DHFS or an entity with which DHFS contracts may enter with  drug  manufacturers or labelers into rebate agreements that take into consideration federal medicaid rebate agreements, the average wholesale  price   of prescription  drugs,  and any other available information on prescription  drug prices and price  discounts. In negotiating a rebate agreement, DHFS may also consider the potential effect of the agreement on MA expenditures. DHFS also may enter into an agreement with another state or with a private organization that represents other states to negotiate rebate agreements with manufacturers and labelers. Under the rebate agreement, the manufacturer or labeler must make  payments  for the manufacturer's or labeler's drugs that are  prescribed and purchased under the program. DHFS must collect from  pharmacies   and pharmacists utilization data necessary to calculate the amounts to be rebated; patient-identifiable data that is collected must be treated by DHFS as  a patient health care record for purposes of confidentiality. The amounts of the rebate  payments  must be paid to the state and, in turn, paid by DHFS to  pharmacies  or pharmacists that have reduced charges for prescription drugs for the eligible persons. If a manufacturer or labeler elects not to enter into a rebate agreement, DHFS must determine, under procedures that are required to be  established by rule, whether to subject the manufacturer's or labeler's  drugs   to prior authorization requirements under MA. DHFS may disseminate to the public information that specifies the names of manufacturers or labelers that elect not to enter into rebate agreements and the  prices  at which the most frequently used prescription  drugs  are available to persons under the program. In addition, DHFS must disseminate to health professionals information about the relative cost of prescription  drugs  of manufacturers or labelers that enter into rebate agreements in comparison with the cost of prescription drugs of manufacturers or labelers that do not enter into rebate agreements. Discrepancies in amounts claimed by pharmacies or pharmacists and amounts rebated by a manufacturer or labeler or in information provided by DHFS to the manufacturer or labeler regarding the rebate may be reviewed by independent auditors. If the discrepancy continues following the audit, additional amounts due must be paid, or DHFS must refund excess payment made, as appropriate. For further controversies, one of the parties may request an administrative hearing. DHFS must request from the secretary of the federal department of health and human services a waiver of any federal medicaid laws necessary to implement the   bill's  prior authorization requirements under MA.


Under the  bill,  DHFS must monitor compliance by  pharmacies  and pharmacists with the requirement to charge eligible persons for the specified prescription drugs at the reduced amounts and annually report to the legislature concerning the compliance. DHFS also must promulgate rules that establish prohibitions against fraud that are substantially similar to MA fraud provisions; the bill specifies penalties applicable to violations of these prohibitions.


The  bill  requires that DHFS promulgate as rules procedures for determining  whether to subject drugs produced by a manufacturer or repackaged by a labeler to prior authorization requirements under MA. In addition, the  pharmacy  examining board must promulgate rules requiring disclosure by a  pharmacist  to  a  drug  purchaser who is a participant under the program of the amount of the discount on the retail  price of the drug  that is provided to the participant under the program.



03/05/2002 INTRODUCED.


03/20/2002 Failed to pass pursuant to Senate Joint Resolution 1.


Sponsor Information:

Kimberly M. Plache (D-Majority); Committees: Finance.  Serving since 1989 (WI Assembly) and 1997 (WI Senate).




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