summary
Introduced
11/02/2021
11/02/2021
In Committee
02/25/2022
02/25/2022
Crossed Over
03/08/2022
03/08/2022
Passed
03/08/2022
03/08/2022
Dead
Signed/Enacted/Adopted
04/08/2022
04/08/2022
Introduced Session
2022 Regular Session
Bill Summary
An act relating to step-therapy protocols; amending s. 627.42393, F.S.; revising the circumstances under which step-therapy protocols may not be required; defining terms; requiring health insurers to publish on their websites and provide to their insureds specified information; providing requirements for procedures for requests and appeals of denials of protocol exemptions; providing requirements for authorizations and denials of protocol exemption requests; authorizing health insurers to request specified documentation under certain circumstances; amending s. 641.31, F.S.; revising the circumstances under which step-therapy protocols may not be required; defining terms; requiring health maintenance organizations to publish on their websites and provide to their subscribers specified information; providing requirements for procedures for requests and appeals of denials of protocol exemptions; providing requirements for authorizations and denials of protocol exemption requests; authorizing health maintenance organizations to request specified documentation under certain circumstances; providing an effective date. hb0459-01-er ENROLLED HB 459 2022 Legislature
AI Summary
This bill amends Florida's existing laws to provide additional protections and requirements related to step-therapy protocols used by health insurers and health maintenance organizations (HMOs). The key provisions of the bill include:
- Defining important terms such as "protocol exemption" and "step-therapy protocol."
- Prohibiting health insurers and HMOs from requiring step-therapy protocols if the patient has previously been approved for the prescription drug under a different health coverage plan.
- Requiring health insurers and HMOs to publish procedures for patients and healthcare providers to request protocol exemptions and appeals of denied requests.
- Specifying the timelines and requirements for authorizing or denying protocol exemption requests, including providing written explanations for denials.
- Allowing health insurers and HMOs to request relevant medical records to support protocol exemption requests.
- Maintaining the existing provisions that do not require health insurers or HMOs to add a drug to their formulary or cover a drug they do not otherwise cover.
The bill aims to provide more transparency and streamlined processes for patients and providers regarding step-therapy protocols used by health plans in Florida.
Committee Categories
Budget and Finance, Health and Social Services
Sponsors (12)
Matt Willhite (D)*,
Robin Bartleman (D),
Christopher Benjamin (D),
Tracie Davis (D),
Anna Eskamani (D),
Christine Hunschofsky (D),
Dotie Joseph (D),
Daisy Morales (D),
Michelle Salzman (R),
Kelly Skidmore (D),
Allison Tant (D),
Geri Thompson (D),
Last Action
Chapter No. 2022-47 (on 04/08/2022)
Official Document
bill text
bill summary
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bill summary
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bill summary
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