Bill > H0697

This bill modifies existing Florida law concerning pharmacy benefits plans and programs, pharmacy benefit managers (PBMs), and the Ryan White Part B AIDS Drug Assistance Program (ADAP). It clarifies that a "pharmacy benefits plan or program" does not include plans exclusively serving a PACE (Program of All-Inclusive Care for the Elderly) organization. Contracts between PBMs and pharmacies will now require an option for pharmacies to submit consolidated administrative appeals for multiple adjudicated claims that share the same drug and supply details within the same calendar month, aiming to streamline the process of challenging reimbursement rates. The bill also introduces new prohibited practices for PBMs, preventing them from restricting pharmacies from refusing to dispense drugs if the reimbursement rate is below their actual acquisition cost, and prohibiting PBMs from reimbursing affiliated pharmacies at a higher rate than non-affiliated ones. Furthermore, it appropriates over $30 million for the implementation of ADAP through June 30, 2026, defining "low income" for ADAP eligibility as an adjusted gross household income at or below 400% of the federal poverty level during this period. ADAP services will be provided through direct medication distribution, not health insurance, and must include all medications on the Florida ADAP Formulary as of March 1, 2026, with specific provisions for individuals with impaired kidney function. The Department of Health is mandated to submit monthly reports detailing ADAP's finances, participant data, and operational status to legislative and executive offices, and is authorized to adopt emergency rules to implement ADAP, which will remain in effect until June 30, 2026.

Budget and Finance, Health and Social Services

Health & Human Services Committee (House)

https://www.flsenate.gov/Session/Bill/2026/697