Bill > H0561

Introduced Session

An act relating to prescription drug coverage; creating s. 627.42394, F.S.; requiring individual and group health insurers to provide notice of prescription drug formulary changes to current and prospective insureds and the insureds' treating physicians; specifying the timeframe and manner in which such notice must be provided; specifying requirements for a notice of medical necessity submitted by the treating physician; authorizing insurers to provide certain means for submitting the notice of medical necessity; requiring the Financial Services Commission to adopt a certain form by rule by a specified date; specifying a coverage requirement and restrictions on coverage modification by insurers receiving such notice; providing construction and applicability; requiring insurers to maintain a record of formulary changes; requiring insurers to annually submit a specified report to the Office of Insurance Regulation; requiring the office to annually compile certain data, prepare a report and make the report publicly accessible on its website, and submit the report to the Governor and the Legislature; creating s. 627.6404, F.S.; requiring insurers to apply certain reductions in out-of-pocket expenses for prescription drugs toward an insured's cost-sharing obligation; creating s. 627.64742, F.S.; defining the term "pharmacy benefit manager"; requiring pharmacy benefit managers to annually file with the office a specified report relating to payments collected from pharmaceutical manufacturers; requiring the office to publish such reports on its website within a certain timeframe; authorizing the commission to adopt rules; amending s. 627.6699, F.S.; requiring small employer carriers to comply with certain requirements for prescription drug formulary changes; amending s. 641.31, F.S.; requiring health maintenance organizations to provide notice of prescription drug formulary changes to current and prospective subscribers and the subscribers' treating physicians; specifying the timeframe and manner in which such notice must be provided; specifying requirements for a notice of medical necessity submitted by the treating physician; authorizing health maintenance organizations to provide certain means for submitting the notice of medical necessity; requiring the commission to adopt a certain form by rule by a specified date; specifying a coverage requirement and restrictions on coverage modification by health maintenance organizations receiving such notice; providing construction and applicability; requiring 51 health maintenance organizations to maintain a record 52 of formulary changes; requiring health maintenance 53 organizations to annually submit a specified report to 54 the office; requiring the office to annually compile 55 certain data, prepare a report and make the report 56 publicly accessible on its website, and submit the 57 report to the Governor and the Legislature; creating 58 s. 641.3157, F.S.; requiring health maintenance 59 organizations to apply certain reductions in out-of-60 pocket expenses for prescription drugs toward a 61 subscriber's cost-sharing obligation; providing 62 applicability; providing a declaration of important 63 state interest; providing an effective date. 64

AI Summary

Committee Categories

Thad Altman (R)*, 

Died in Health Market Reform Subcommittee (on 03/14/2020)

Official Document