Section 49.686. AZT and pentamidine reimbursement program.

 

(1)   Definitions. In this section:

(a) “AIDS" means acquired immunodeficiency syndrome.

(am) “AZT" means the drug azidothymidine.

(b) “Gross income" means all income, from whatever source derived and in whatever form realized, whether in money, property or services.

(c) “HIV" means any strain of human immunodeficiency virus, which causes acquired immunodeficiency syndrome.

(d) “HIV infection" means the pathological state produced by a human body in response to the presence of HIV.

(e) “Physician" has the meaning specified in s. 448.01 (5) .

(f) “Residence" means the concurrence of physical presence with intent to remain in a place of fixed habitation. Physical presence is prima facie evidence of intent to remain.

(2)   Reimbursement. From the appropriation accounts under s. 20.435 (1) (am) , (i) , and (ma) , the department may reimburse or supplement the reimbursement of the cost of AZT, the drug pentamidine, and any drug approved for reimbursement under sub. (4) (c) for an individual who is eligible under sub. (3) .

(3)   Eligibility. An individual is eligible to receive the reimbursement specified under sub. (2) if he or she meets all of the following criteria:

(a) Has residence in this state.

(b) Has an infection that is certified by a physician to be an HIV infection.

(c) Has a prescription issued by a physician for AZT, for pentamidine or for a drug approved for reimbursement under sub. (4) (c) .

(d) Has applied for coverage under and has been denied eligibility for medical assistance within 12 months prior to application for reimbursement under sub. (2) . This paragraph does not apply to an individual who is eligible for benefits under the demonstration project for childless adults under s. 49.45 (23) or to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471 (11) .

(e) Has no insurance coverage for AZT, the drug pentamidine or any drug approved for reimbursement under sub. (4) (c) or, if he or she has insurance coverage, the coverage is inadequate to pay the full cost of the individual's prescribed dosage of AZT, the drug pentamidine or any drug approved for reimbursement under sub. (4) (c) .

(f) Is an individual whose annual gross household income is at or below 200 percent of the poverty line and, if funding is available under s. 20.435 (1) (i) or (m) , is an individual whose annual gross household income is above 200 percent and at or below 300 percent of the poverty line.

(4)   Departmental duties. The department shall do all of the following:

(a) Determine the eligibility of individuals applying for reimbursement, or a supplement to the reimbursement, of the costs of AZT or the drug pentamidine.

(b) Within the limits of sub. (5) and of the funds specified under sub. (2) and under a schedule that the department shall establish based on the ability of individuals to pay, reimburse or supplement the reimbursement of the eligible individuals.

(c) After consulting with individuals, including those not employed by the department, with expertise in issues relative to drugs for the treatment of HIV infection and AIDS, determine which, if any, drugs that are cost-effective alternatives to AZT and pentamidine may also have costs reimbursed under this section.

(5)   Reimbursement limitation. Reimbursement may not be made under this section for any portion of the costs of AZT, the drug pentamidine or any drug approved for reimbursement under sub. (4) (c) which are payable by an insurer, as defined in s. 600.03 (27) .

1989 a. 31 ; 1991 a. 39 ; 1993 a. 16 ; 1995 a. 27 ss. 3061 to 3062d ; Stats. 1995 s. 49.686; 1997 a. 27 ; 2001 a. 81 ; 2007 a. 20 , 89 ; 2009 a. 28 , 209 ; 2013 a. 20 .