• Establishing the Office of Prescription Drug Affordability to oversee prescription drug regulations and further analyze and develop policies aimed at reducing prescription drug costs for Wisconsinites statewide;  
• Lowering everyday, out-of-pocket costs for Wisconsinites, including working families, seniors, and expecting parents by: 
  • Making essential healthcare products more affordable and accessible by exempting over-the-counter medications from sales tax. This will reduce sales taxes on consumers by $29.8 million in fiscal year 2025-26 and $40.8 million in fiscal year 2026-27. 
  • Making basic family needs, including diapers, incontinence products, menstrual products, and breast pumps, exempt from sales tax. This will reduce sales taxes on families by $14.9 million in fiscal year 2025-26 and $20.4 million in fiscal year 2026-27. 
• Ensuring insulin is affordable for Wisconsinites by establishing a $35 maximum copay cap for a month’s supply of insulin; Establishing an Insulin Safety Net Program to ensure those with an urgent need for insulin, as well as those with lower incomes and limited-to-no insurance coverage, have access to affordable insulin; 
• Establishing a value-based diabetes medication pilot program to develop a value-based formulary, focus on medications that work, and reduce spending waste; 
• Requiring prescription drug cost reductions received from prescription drug manufacturer coupons and other discounts to count towards a plan holder’s deductible or out-of-pocket maximum. Only discounts for brand-name drugs that have no generic equivalent and brand-name drugs that have undergone prior authorization by a prescriber or the insurer are eligible in order to avoid incentivizing the purchasing of more expensive brand-name drugs over their generic equivalents; 
• Requiring health insurance plans offered in the state to cover over-the-counter oral contraception to increase the accessibility and affordability of an essential component of women’s health. Health insurance plans would be prohibited from requiring an individual to have a prescription for the oral contraceptive in order to be provided coverage; 
• Improving oversight of drug companies by creating a Prescription Drug Affordability Review Board to oversee the pharmaceutical industry and drug market, analyze other state and national drug policies and practices, establish spending limits for public sector entities, and set price ceilings on price-gouging prescription drugs; 
• Licensing and regulating entities involved in the prescription drug supply chain, including pharmacy benefit management brokers and consultants, pharmacy services administration organizations, and pharmaceutical sales representatives; 
• Requiring pharmacy benefit managers and other third-party payers to reimburse certain 340B drug discount program participants, specifically federally qualified health centers, critical access hospitals and Ryan White HIV/AIDS programs, at the same rate that non-340B program participants are reimbursed to end discriminatory reimbursement practices; 
• Requiring pharmacy benefit managers to owe a fiduciary duty to insurers and other payers with whom they contract; 
• Creating a Prescription Drug Importation Program that would allow the state to import drugs that would create substantial savings for Wisconsin consumers and taxpayers; and 
• Directing the Wisconsin Office of the Commissioner of Insurance (OCI) to study the creation of a state prescription drug purchasing entity. 

LOWERING OUT-OF-POCKET COSTS FOR HIGH-QUALITY HEALTHCARE COVERAGE, HOLDING INSURANCE COMPANIES ACCOUNTABLE, AND IMPROVING INSURANCE TRANSPARENCY

Gov. Evers believes healthcare should not be a privilege afforded only to the healthy and the wealthy. No one should ever have to choose between life-saving medication and care or putting food on the table and keeping a roof over their head. That’s why the governor is calling on the Legislature to join him in supporting legislation to:  

• Create a first-of-its-kind process for auditing insurers when their claims denial rates are too high. The state would provide a corrective action plan for the insurer, with enforcement power to determine that the corrective action plan is being followed and ensure claims are not being unjustifiably denied; 
• Create a new consumer protection office for the first time in state history that is designed to help Wisconsinites whose insurance claims are denied and make sure Wisconsinites can hold health insurance accountable by getting the coverage they pay for; 
• Enact a number of prior authorization requirement reforms to improve efficiency, expedite the process, and get individuals the care they need; 
• Prohibit insurers from requiring prior authorization for inpatient mental health services for kids and adults, ensuring that individuals get that critical care without delay; 
• Require insurers to list all covered services under each plan that require prior authorization so that the information is clearly disclosed to individuals before purchasing a plan; 
• Prohibit health insurance providers from establishing annual or lifetime limits on health insurance plan benefits and require all health insurance plans to provide coverage for essential health benefits as determined by the commissioner of OCI, including the ten essential health benefits categories covered under the federal ACA, and to provide coverage for certain preventive services at no cost to the plan holder; 
• Establish network adequacy standards to improve access to services by requiring in-network services to be within set travel times and distances from the plan holder, and explore standards for appointment wait times, making sure that individuals get access to services within a reasonable number of business days; 
• Codify federal law to curb surprise billing for emergency services and reduce medical costs and protect against receiving unreasonably high medical bills for ground ambulance services and certain behavioral health services received during a crisis; 
• Expand coverage protections and provide parity for those telehealth services; and  
• Add pregnancy to the list of qualifying life events for individuals to enroll in healthcare coverage during health insurance special enrollment periods.

ADDITIONAL BACKGROUND ON EVERS ADMINISTRATION’S EFFORTS TO EXPAND ACCESS TO QUALITY, AFFORDABLE HEALTHCARE IN THE 2025-27 BIENNIAL BUDGET

In addition to fighting efforts by the Trump Administration to cut healthcare coverage, the Evers Administration has been committed to expanding access to affordable, high-quality healthcare statewide.  

Gov. Evers believes healthcare should not be a privilege afforded only to the healthy and the wealthy. No one should ever have to choose between life-saving medication and care or putting food on the table and keeping a roof over their head. Wisconsinites should be able to get the healthcare they need when and where they need it, and without breaking the bank.

The final 2025-27 Biennial Budget was signed into law by Gov. Evers on July 3, 2025, just a day before President Trump’s budget reconciliation bill was signed into law, which prohibited states from creating new or increased provider taxes, locking them into the current rates. The biennial budget secured a final increase to Wisconsin’s hospital tax rate, as well as an additional $1.1 billion to support healthcare access across Wisconsin, especially in rural communities, that would have been jeopardized had the president's bill been enacted first. In addition to securing the additional $1.1 billion, the 2025-27 Biennial Budget signed into law by Gov. Evers makes historic investments to support Wisconsin’s healthcare industry and ensure Wisconsinites have access to quality, affordable healthcare—especially in rural areas—with new efforts to bolster health systems across the state, including:  

• Continuing funding for BadgerCare; 
• Over $53 million to increase Medicaid reimbursement rates for personal care, obstetrics, private duty nursing, residential opioid treatment, and home health services, and more;   
• Fully funding the minimum fee schedule implemented by the Department of Health Services last biennium to help long-term care facilities avoid staffing cuts and closures;   
• $1.5 million in increased funding over the biennium for free and charitable clinics;   
• $7 million to support crisis intervention through the 988 Suicide and Crisis Lifeline;   
• $2 million to support the WisCaregiver Career Program to help address the state's shortage of certified nursing assistants and direct care professionals; and   
• $3.8 million to support Aging and Disability Resource Centers across the state, among many other critical provisions.  

Gov. Evers also exercised his broad, constitutional veto authority to partially veto aspects of the budget that were outside of the bipartisan budget negotiations. More information about the bipartisan pro-kid budget signed by Gov. Evers is available here.