Bill > H5015

This bill modifies Florida's state group insurance prescription drug program, specifically focusing on formulary management for prescription drugs and supplies. Starting in the 2026 plan year, the Department of Management Services (DMS) must implement formulary management practices that allow for drug inclusion or exclusion while maintaining access to clinically appropriate and cost-effective medications. By September 1, 2025, DMS must submit recommendations to the Governor and Legislative Budget Commission regarding formulary management, including lists of excluded and included prescription drugs, prior authorization protocols, and step therapy guidelines. The Legislative Budget Commission can review and approve these recommendations, and DMS will only implement the approved recommendations. The bill also requires DMS to submit a list of excluded prescription drugs and supplies, which must be approved by the Legislative Budget Commission. Notably, the bill removes the previous requirement that excluded drugs must be available if a healthcare provider certifies medical necessity, and it stipulates that new prescription drugs and supplies introduced after January 1, 2026, will not be covered until specifically included in the covered drugs list. The changes aim to provide more structured and cost-effective management of the state employees' prescription drug program.

House Budget Committee (House)

https://www.flsenate.gov/Session/Bill/2025/5015