Wisconsin

Wisconsin has no DPC laws at present, but there are multiple DPC practices in operation. Prior legislative efforts were made in 2017 with Senate Bill 670 and in 2019 with Senate Bill 28. We anticipate that another effort will be made in the 2022 legislative session to clarify that DPC is not insurance while simultaneously initiating a Medicaid direct primary care pilot program.

Here were some of my comments about PRIOR legislative efforts in 2017 and 2019:

Section 1(3)(a) comes dangerously close to the old HMO gatekeeper provision and I am not convinced that the language in Section 1(3)(b) will be easily enforced.

Section 2(2)(h) is missing important language. As written this section prohibits employers, Medicaid (the pilot proposed in Section 1) or theoretically the patient's Grandma from paying the monthly DPC fee. I would propose the following language addition. "The health care provider and the patient are prohibited from billing an insurer or any other third party on a fee for service basis for the routine health care services provided under the Agreement.

Section 2(3) is not the ideal scenario. If this language was what it took to get the insurance commissioner's office to withdraw their objection, then okay. Ideally this entire section should not be needed. DPC physicians should be policed by the medical board, not the department of insurance.

Be sure to review the Wisconsin Insurance Code when planning your DPC practice.

Here is the language of the Wisconsin Dispensing Law:

Chapter Med 17 STANDARDS FOR DISPENSING AND PRESCRIBING DRUGS

Med 17.01 Authority and purpose.

(1) The rules in this chapter are adopted pursuant to authority in ss. 15.08 (5) (b), 227.11 and ch. 448, Stats.

(2) The rules in this chapter are adopted to specify standards practitioners shall follow in dispensing prescription drugs for the protection of the public.

Med 17.02 Definitions.

(1) “ Controlled substance" has the meaning under s. 961.01 (4), Stats.

(2) “Practitioner" means a person holding a license to practice medicine and surgery.

(3) “Prescription drug" has the meaning under s. 450.01 (20), Stats.

Med 17.03 Packaging. A prescription drug dispensed by a practitioner shall be dispensed in a child-resistant container if it is a substance requiring special packaging under 16 CFR 1700.14 (1982) of the federal poison prevention packaging act.

Med 17.04 Labeling.

(1) A prescription drug dispensed by a practitioner shall contain a legible label affixed to the immediate container disclosing:

(a) The name and address of the facility from which the prescribed drug is dispensed;

(b) The date on which the prescription is dispensed;

(d) The full name of the patient;

(e) The generic name and strength of the prescription drug dispensed unless the prescribing practitioner requests omission of the name and strength of the drug dispensed; and,

(f) Directions for use of the prescribed drug and cautionary statements, if any, contained in the prescription or required by law.

(2) Nonapplication of labeling requirements. The labeling requirement specified in sub. (1) does not apply to complimentary samples dispensed by a practitioner in original containers or packaging supplied to the practitioner by a pharmaceutical manufacturer or distributor.

Med 17.05 Recordkeeping.

(1) Prescription drugs.

(a) A practitioner shall maintain complete and accurate records of each prescription drug received, dispensed or disposed of in any other manner.

(b) All prescription drugs dispensed by a practitioner shall be recorded in the patient record.

(2) Controlled substances.

(a) Records required by the federal controlled substances act and ch. 961, Stats., shall be maintained at the location where the drug is received, distributed or dispensed and be available for inspection by authorized persons for at least 5 years from the date of such record.

(b) Controlled substances dispensed by a practitioner shall be recorded as follows:

1. As provided in this section; and

2. On a separate log, in a separate bound log book in which each schedule of controlled substances dispensed is recorded separately and in chronological order with the following information:

a. The name of the substance.

b. Dosage form and strength of the substance.

c. Name and address of the person for whom dispensed.

d. Date of dispensing.

e. Quantity dispensed.

f. Name or initials of practitioner who dispensed the substance.

Med 17.06 Prescription orders by nurses and ancillary health care personnel. Prescription orders prepared by professional nurses and ancillary health care personnel, as delegated and supervised by a practitioner under s. 448.03 (2) (e), Stats., shall contain in addition to other information required by this chapter, the name, address and telephone number of the delegating practitioner and the name, address and signature of the person preparing the prescription order.

Physician Assistants are allowed to dispense medications in Wisconsin.

PA 3.06 Standards for dispensing and prescribing drugs.

(1) Prescriptive authority.

(a) A physician assistant may order, prescribe, procure, dispense, and administer prescription drugs, medical devices, services, and supplies.

(b) A physician assistant practicing under the supervision and direction of a podiatrist may issue a prescription order for a drug or device in accordance with guidelines established by the supervising podiatrist and the physician assistant.

(2) Packaging. A prescription drug dispensed by a physician assistant shall be dispensed in a child-resistant container if it is a substance requiring special packaging under 16 CFR 1700.14 (1982) of the federal regulations for the federal poison packaging act of 1970.

(3) Labeling. A prescription drug dispensed by a physician assistant shall contain a legible label affixed to the immediate container disclosing all of the following:

(a) The name and address of the facility from which the prescribed drug is dispensed.

(b) The date on which the prescription is dispensed.

(d) The full name of the patient.

(e) The generic name and strength of the prescription drug dispensed unless the prescribing physician assistant requests omission of the name and strength of the drug dispensed.

(f) Directions for the use of the prescribed drug and cautionary statements, if any, contained in the prescription or required by law.

(4) Recordkeeping.

(a) Unless otherwise maintained by an organization, a physician assistant shall maintain complete and accurate records of each prescription drug received, dispensed, or disposed of in any other manner.

(b) Records for controlled substances shall be maintained as required by the federal controlled substances act and ch. 961, Stats.

Nurse Practitioners are not permitted to dispense medications in Wisconsin. According to Published under s. 35.93, Wis. Stats., by the Legislative Reference Bureau Chapter N, 8, Certification of Advanced Practice Nurse Prescribers: N 8.09 Dispensing. (1) Except as provided in sub. (2), advanced practice nurse prescribers shall restrict their dispensing of prescription drugs to complimentary samples dispensed in original containers or packaging supplied by a pharmaceutical manufacturer or distributor. (2) An advanced practice nurse prescriber may dispense drugs to a patient at the treatment facility at which the patient is treated.