Bill > S0742

This bill aims to address several aspects of pharmacy benefit management in Florida. Key provisions include: 1. Requiring that any pharmacy willing to accept reasonable terms and conditions be included in a managed care plan's pharmacy network, and prohibiting the exclusive use of mail-order pharmacies to meet network access standards. 2. Requiring managed care plans using pharmacy benefit managers (PBMs) to reimburse Medicaid pharmacy providers and dispensing practitioners based on the National Average Drug Acquisition Cost (NADAC) plus a dispensing fee. 3. Authorizing the Office of Insurance Regulation to examine PBMs and suspend or revoke their registration or impose fines for violations, such as breaching fiduciary duty, using spread pricing, reducing payments to pharmacies, or requiring the use of affiliated pharmacies or mail-order. 4. Establishing various requirements and rights related to pharmacy audits conducted by health insurers, health maintenance organizations, and PBMs. 5. Prohibiting PBMs from charging certain fees to pharmacists/pharmacies or retroactively denying or reducing payments for covered claims. Overall, the bill aims to increase transparency and regulate the practices of PBMs in order to protect pharmacies and ensure access to medications for Medicaid enrollees.

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https://www.flsenate.gov/Session/Bill/2022/742