summary
Introduced
12/12/2025
12/12/2025
In Committee
12/12/2025
12/12/2025
Crossed Over
Passed
Dead
Introduced Session
2025-2026 Regular Session
Bill Summary
This bill prohibits an insurer, pharmacy benefit manager, or utilization review organization from requiring a step therapy protocol for a drug that is prescribed for metastatic cancer or a cancer-associated condition and the use of the drug is approved by the federal Food and Drug Administration, consistent with best practices for the treatment of metastatic cancer or the cancer-associated condition, and supported by peer-reviewed publications that are based on evidence-based research. A step therapy protocol, as defined in current law, establishes a specific sequence in which medically appropriate prescription drugs are covered by a policy or plan. Current law requires insurers, pharmacy benefit managers, and utilization review organizations to use clinical review criteria for establishing a step therapy protocol that are based on clinical practice guidelines that meet certain specific criteria and to provide access to a process to request an exception to the step therapy protocol. LRB-5532/1 EKL:cdc 2025 - 2026 Legislature SENATE BILL 765
AI Summary
This bill prohibits insurance companies, pharmacy benefit managers, and utilization review organizations from requiring step therapy protocols (a process that requires patients to try less expensive medications before approving coverage for a prescribed drug) for certain cancer drugs. Specifically, the bill applies to drugs prescribed for metastatic cancer (cancer that has spread from its original site to other parts of the body) or cancer-associated conditions (symptoms or side effects related to metastatic cancer that could further harm a patient if untreated). The drug must meet three specific criteria to be exempt from step therapy: it must be FDA-approved, consistent with best medical practices for treating the specific cancer or condition, and supported by peer-reviewed research based on scientific evidence. The bill also adds definitions for "metastatic cancer" and "cancer-associated condition" to the state statutes, providing clear legal terminology for implementing this protection for cancer patients seeking specific medication treatments.
Committee Categories
Agriculture and Natural Resources
Sponsors (20)
Dianne Hesselbein (D)*,
André Jacque (R)*,
LaTonya Johnson (D)*,
Melissa Ratcliff (D)*,
Mark Spreitzer (D)*,
Margaret Arney (D),
Mike Bare (D),
Ryan Clancy (D),
Ben DeSmidt (D),
Alex Joers (D),
Tara Johnson (D),
Lori Palmeri (D),
Christian Phelps (D),
Ann Roe (D),
Christine Sinicki (D),
Ryan Spaude (D),
Angela Stroud (D),
Shelia Stubbs (D),
Lisa Subeck (D),
Angelito Tenorio (D),
Last Action
Read first time and referred to Committee on Insurance, Housing, Rural Issues and Forestry (on 12/12/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://docs.legis.wisconsin.gov/2025/proposals/reg/sen/bill/sb765 |
| BillText | https://docs.legis.wisconsin.gov/document/proposaltext/2025/REG/SB765.pdf |
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