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AB921 • 2025
cost-sharing cap on insulin
The latest official action shows that this bill did not move forward in that session.
Using official source text because the generated explanation was unavailable or could not be confirmed against the official bill text.
cost-sharing cap on insulin Status: A - Insurance
Failed to pass pursuant to Senate Joint Resolution 1
Representative J. Jacobson added as a coauthor
Representative Subeck added as a coauthor
Representative Sheehan added as a coauthor
Commissioner of Insurance report received pursuant to s.601.423(2), Wisconsin Statutes
Representative Kaufert added as a coauthor
Introduced by Representatives Billings , Arney , Clancy , DeSmidt , Goodwin , Joers , Miresse , Moore Omokunde , Neubauer , Prado , Roe , Sinicki , Snodgrass , Spaude , Stubbs and Udell ; cosponsored by Senators Pfaff , Dassler-Alfheim , Hesselbein , Ratcliff , Roys , Smith , Spreitzer , Wall , Wirch and Larson
Read first time and referred to Committee on Insurance
cost-sharing cap on insulin Status: A - Insurance
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Referred to Committee on Insurance. AB921,1,3 1 An Act to renumber and amend 632.895 (6); to amend 609.83 and 632.895 2 (6) (title); to create 632.895 (6) (b) of the statutes; relating to: cost-sharing 3 cap on insulin. Analysis by the Legislative Reference Bureau This bill prohibits every health insurance policy and governmental self-insured health plan that covers insulin and imposes cost sharing on prescription drugs from imposing cost sharing on insulin in an amount that exceeds $35 for a one-month supply. Current law requires every health insurance policy that provides coverage of expenses incurred for treatment of diabetes to provide coverage for specified expenses and items, including insulin. The required coverage under current law for certain diabetes treatments other than insulin infusion pumps is subject to the same exclusions, limitations, deductibles, and coinsurance provisions of the policy as other covered expenses. The bill’s cost-sharing limitation on insulin supersedes the specification that the exclusions, limitations, deductibles, and coinsurance are the same as for other coverage. This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats. The people of the state of Wisconsin, represented in senate and assembly, do enact as follows: AB921,1 1 Section 1 . 609.83 of the statutes is amended to read: AB921,2,4 2 609.83 Coverage of drugs and devices. Limited service health 3 organizations, preferred provider plans, and defined network plans are subject to 4 ss. 632.853, 632.861, and 632.895 (6) (b), (16t) , and (16v). AB921,2 5 Section 2 . 632.895 (6) (title) of the statutes is amended to read: AB921,2,7 6 632.895 (6) (title) Equipment and supplies for treatment of diabetes ; 7 insulin . AB921,3 8 Section 3 . 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and 9 amended to read: AB921,2,20 10 632.895 (6) (a) Every disability insurance policy which that provides coverage 11 of expenses incurred for treatment of diabetes shall provide coverage for expenses 12 incurred by the installation and use of an insulin infusion pump, coverage for all 13 other equipment and supplies, including insulin or any other prescription 14 medication, used in the treatment of diabetes, and coverage of diabetic self- 15 management education programs. Coverage Except as provided in par. (b), 16 coverage required under this subsection shall be subject to the same exclusions, 17 limitations, deductibles, and coinsurance provisions of the policy as other covered 18 expenses, except that insulin infusion pump coverage may be limited to the 19 purchase of one pump per year and the insurer may require the insured to use a 20 pump for 30 days before purchase. AB921,4 21 Section 4 . 632.895 (6) (b) of the statutes is created to read: AB921,2,22 22 632.895 (6) (b) 1. In this paragraph: AB921,3,2 1 a. “Cost sharing” means the total of any deductible, copayment, or 2 coinsurance amounts imposed on a person covered under a policy or plan. AB921,3,3 3 b. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c). AB921,3,6 4 2. Every disability insurance policy and self-insured health plan that covers 5 insulin and imposes cost sharing on prescription drugs may not impose cost sharing 6 on insulin in an amount that exceeds $35 for a one-month supply of insulin. AB921,3,10 7 3. Nothing in this paragraph prohibits a disability insurance policy or self- 8 insured health plan from imposing cost sharing on insulin in an amount less than 9 the amount specified under subd. 2. Nothing in this paragraph requires a disability 10 insurance policy or self-insured health plan to impose any cost sharing on insulin. AB921,5 11 Section 5 . Effective date. AB921,3,13 12 ( 1 ) This act takes effect on the first day of the 4th month beginning after 13 publication. AB921,3,14 14 (end) Down Down /2025/related/proposals/ab921 true proposaltext /2025/related/proposals/ab921 proposaltext/2025/REG/AB921 proposaltext/2025/REG/AB921 section true Menu » 2025 » Related Documents » Proposal Text » AB921: Bill Text × Details for PDF view Link (Permanent link) Bookmark this location View toggle Go to top of document Search in this chapter Search in this section Search in this agency Search in this chapter group Search in this chapter Search in this section Cross references for section Acts affecting this section References to this 1970 Statutes Annotations Appellate Court Citations Administrative Code Index Reference lines Clear highlighting