Health Care Issues Moving in the Legislature

Although the legislature is not planning to meet in March and may not meet in April, too, for floor action, several notable health care related bills are making their way through committees. Below is an overview of major health care issues this session and their current status in the legislative process.

Dental Therapists – Introduced in both the Senate and Assembly; in Gov. Evers’s budget

Authors: Rep. Mary Felzkowski (R-Irma), Sen. David Craig (R-Big Bend)

Committees: Senate Health & Human Services, Assembly Medicaid Reform & Oversight

SB 89/AB 81 would create a new license under the Dental Examining Board for “dental therapists,” an intermediate level of dentistry practice between hygienists and dentists. Dental therapists would perform certain services under the general supervision of a dentist with a collaborative management agreement. The dentist need not be present for the dental therapist to practice. A single dentist may have collaborative agreements with no more than five dental therapists at a time.

Gov. Tony Evers also included dental therapist licensing in his proposed budget’s dental plan. The Evers plan would create a “dental therapist” license and provide $1.5 million for dental therapists training.

Several insurance and provider groups are supporting the dental therapists initiative, while the Wisconsin Dental Association is opposed.

Pharmacy Benefit Managers – Introduced in Senate, Circulating in Assembly; in Gov. Evers’s budget

Authors: Sen. Jon Erpenbach (D-Middleton), Sen. Roger Roth (R-Appleton), Rep. Michael Schraa (R-Oshkosh), Rep. Deb Kolste (D-Janesville)

Committees: Senate Health & Human Services

SB 100/LRB 448 would allow the Office of the Commissioner of Insurance (OCI) to regulate pharmacy benefit managers (PBMs) and would create certain transparency requirements for PBMs. Under the bill, certain PBMs must register with OCI, and certain PBMs must be licensed by the Pharmacy Examining Board. The bill gives OCI rulemaking authority to regulate PBMs. Gov. Evers has included similar provisions in his proposed budget.

Minimum Markup of Prescription Drugs – Various Bills Introduced and Circulating

Wisconsin’s “Unfair Sales Act” (Wis. Stat. §100.30) prohibits the sale of merchandise, including prescription drugs, at less than cost as “loss leaders.” Several legislators are currently circulating bills that would amend or repeal the Unfair Sales Act to lower costs for consumers on prescription drugs.

Sen. Tim Carpenter (D-Milwaukee) has introduced a bill (SB 22, in Senate Committee on Economic Development, Commerce & Trade) that would exempt prescription drugs from the Unfair Sales Act, allowing prescription drugs to be sold at less than cost. Rep. Jim Ott (R-Mequon) and Sen. Duey Stroebel (R-Saukville) have circulated LRB 1031, which exempts prescription drugs and general merchandise from the Unfair Sales Act but keeps in place requirements for gas, groceries, alcohol, and tobacco. Ott, Stroebel, and Sen. Dave Craig (R-Big Bend) have also circulated LRB 1032, which repeals the Unfair Sales Act altogether. LRB 1032 would eliminate the prohibition on below-cost sales for prescription drugs and all other merchandise.

Step Therapy – Introduced in both the Senate and Assembly

Authors: Rep. John Nygren (R-Marinette), Sen. Alberta Darling (R-River Hills)

Committees: Senate Health & Human Services, Assembly Health

SB 26/AB 24 would change insurance companies’ step therapy protocols. Under the bill, insurers must establish protocols for making exceptions to step therapy and base their protocols on certain criteria specified in the bill.

Direct Primary Care – Introduced in both the Senate and Assembly

Authors: Sen. Chris Kapenga (R-Delafield), Rep. Joe Sanfelippo (R-New Berlin) 

Committees: Senate Health & Human Services, Assembly Small Business Development

SB 28/AB 26 would establish parameters for the practice of direct primary care (DPC) in Wisconsin. The bill is largely the same as the version that passed the Assembly last session (Assembly Substitute Amendment 1 to AB 798) but failed in the Senate. The bill would define DPC agreements under Wisconsin law and require particular consumer disclosures. Under the bill as passed by the Assembly, a DPC agreement would have to state prominently that such an agreement is not health insurance and that DPC fees might not be credited towards deductibles or out-of-pocket maximum amounts under the patient’s health insurance.

A study committee last summer examined the issue of DPC in Wisconsin but declined to recommend new legislation.

Pre-existing Conditions – Passed Assembly, Introduced in Senate; in Gov. Evers’s Budget

Authors: Sen. Andre Jacque (R-DePere), Rep. Kevin Peterson (R-Waupaca)

Committees: Senate Health & Human Services, Assembly Health

AB 1/SB 2 would place a state-level prohibition on pre-existing conditions exclusions, if the Affordable Care Act is repealed or is otherwise unenforceable. The Assembly passed AB 1 76-19 in their first floor session of the year on Jan. 22. The Senate has not indicated whether or when they would consider the pre-existing conditions legislation.

Meanwhile, in his budget proposal, Gov. Evers included provisions requiring certain health plans to not only prohibit pre-existing conditions exclusions but also to guarantee access to coverage, prohibit lifetime or annual limits on benefits, and require coverage of essential health benefits, among other mandates. If signed into law, the governor’s proposal would be effective immediately, regardless of the status of the Affordable Care Act.