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Bill > AB246

WI AB246

Cost-sharing caps on prescription drugs and medical supplies to treat asthma under health insurance policies and plans. (FE)

summary

Introduced
05/08/2025
In Committee
05/08/2025
Crossed Over
Passed
Dead

Introduced Session

2025-2026 Regular Session

Bill Summary

This bill requires health insurance policies and plans that provide coverage of prescription drugs to cover prescription drugs and related medical supplies for the treatment of asthma. This bill provides that Xrelated medical suppliesY includes asthma inhalers and other medical supply items necessary to effectively and appropriately administer a prescription drug prescribed to treat asthma. This bill requires policies and plans to limit the amount of any enrollee cost-sharing for the coverage provided in the bill to no more than $25 per one-month supply for each prescription drug prescribed to treat asthma and to no more than $50 per month for all related medical supplies. Cost-sharing may not increase with the number of conditions for which an enrollee is treated. Further, the coverage provided in the bill may not be subject to any deductible. However, the bill provides that the limitations on cost-sharing and deductibles do not apply to the extent that the limitations would result in ineligibility for a health savings account under the federal Internal Revenue Code. This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats. For further information see the state fiscal estimate, which will be printed as an appendix to this bill.

AI Summary

This bill requires health insurance policies and plans in Wisconsin that cover prescription drugs to provide coverage for prescription drugs and related medical supplies used to treat asthma, with specific cost-sharing limitations. The bill defines "related medical supplies" as asthma inhalers and other medical supply items necessary to effectively administer asthma prescription drugs. Specifically, insurers must limit enrollee cost-sharing to no more than $25 per month for each prescription drug treating asthma and $50 per month for related medical supplies. These cost-sharing limits cannot increase based on the number of conditions an enrollee is treating, and the coverage cannot be subject to a deductible. However, to maintain compliance with federal health savings account (HSA) regulations, the cost-sharing limitations may be adjusted for high-deductible health plans to ensure HSA eligibility. The bill will take effect on the first day of the fourth month after its publication and will initially apply to policy or plan years beginning on its effective date, with special provisions for policies governed by collective bargaining agreements.

Committee Categories

Health and Social Services

Sponsors (41)

Clint Anderson (D)*,  Deb Andraca (D)*,  Margaret Arney (D)*,  Mike Bare (D)*,  Brienne Brown (D)*,  Ryan Clancy (D)*,  Ben DeSmidt (D)*,  Jodene Emerson (D)*,  Joan Fitzgerald (D)*,  Jenna Jacobson (D)*,  Alex Joers (D)*,  Tara Johnson (D)*,  Darrin Madison (D)*,  Renuka Mayadev (D)*,  Maureen McCarville (D)*,  Vincent Miresse (D)*,  Supreme Moore Omokunde (D)*,  Greta Neubauer (D)*,  Sylvia Ortiz-Velez (D)*,  Lori Palmeri (D)*,  Christian Phelps (D)*,  Pricilla Prado (D)*,  Ann Roe (D)*,  Joe Sheehan (D)*,  Lee Snodgrass (D)*,  Ryan Spaude (D)*,  Angela Stroud (D)*,  Shelia Stubbs (D)*,  Lisa Subeck (D)*,  Angelito Tenorio (D)*,  Randy Udell (D)*,  Kristin Dassler-Alfheim (D),  Dora Drake (D),  Dianne Hesselbein (D),  LaTonya Johnson (D),  Sarah Keyeski (D),  Chris Larson (D),  Melissa Ratcliff (D),  Kelda Roys (D),  Mark Spreitzer (D),  Bob Wirch (D), 

Last Action

Fiscal estimate received (on 05/21/2025)

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