Bill > S1166

Introduced Session

An act relating to insurer disclosures on prescription drug coverage; creating s. 627.42394, F.S.; requiring individual and group health insurers to provide notice of prescription drug formulary changes within a certain timeframe to current and prospective insureds and the insureds’ treating physicians; specifying requirements for the content of such notice and the manner in which it 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 a notice of medical necessity; 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 by a specified date; requiring the office to annually compile certain data and prepare a report, make the report publicly accessible on its website, and submit the report to the Governor and the Legislature by a specified date; creating s. 627.6383, F.S.; defining the term “cost sharing requirement”; requiring specified individual health insurers and their pharmacy benefit managers to apply payments for prescription drugs by or on behalf of insureds toward the insureds’ total contributions to cost-sharing requirements under certain circumstances; providing construction; requiring specified individual health insurers to maintain records of certain third-party payments for prescription drugs; providing reporting requirements relating to third-party payments for prescription drugs; providing requirements for the reports; providing applicability; amending s. 627.6385, F.S.; providing disclosure requirements relating to a policyholder’s total cost-sharing requirement for prescription drugs; providing applicability; amending s. 627.64741, F.S.; requiring that specified contracts require pharmacy benefit managers to apply payments by or on behalf of insureds toward the insureds’ total contributions to cost-sharing requirements; providing applicability; providing disclosure requirements relating to a policyholder’s total cost-sharing requirement for prescription drugs; creating s. 627.65715, F.S.; defining the term “cost-sharing requirement”; requiring specified group health insurers and their pharmacy benefit managers to apply payments for prescription drugs by or on behalf of insureds toward the insureds’ total contributions to cost-sharing requirements under certain circumstances; providing construction; providing disclosure requirements relating to an insured person’s total cost-sharing requirement for prescription drugs; requiring specified group health insurers to maintain records of certain third-party payments for prescription drugs; providing reporting requirements; providing requirements for the reports; providing applicability; amending s. 627.6572, F.S.; requiring that specified contracts require pharmacy benefit managers to apply payments by or on behalf of insureds toward the insureds’ total contributions to cost sharing requirements; providing applicability; providing disclosure requirements; 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.; providing an exception to requirements relating to changes in a health maintenance organization’s group contract; requiring health maintenance organizations to provide notice of prescription drug formulary changes within a certain timeframe to current and prospective subscribers and the subscribers’ treating physicians; specifying requirements for the content of such notice and the manner in which it 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 a notice of medical necessity; providing construction and applicability; requiring health maintenance organizations to maintain a record of formulary changes; requiring health maintenance organizations to annually submit a specified report to the office by a specified date; requiring the office to annually compile certain data and prepare a report, make the report publicly accessible on its website, and submit the report to the Governor and the Legislature by a specified date; defining the term “cost-sharing requirement”; requiring specified health maintenance organizations and their pharmacy benefit managers to apply payments for prescription drugs by or on behalf of subscribers toward the subscribers’ total contributions to cost-sharing requirements under certain circumstances; providing construction; providing disclosure requirements relating to the subscriber’s total contributions to cost-sharing requirements; requiring specified health maintenance organizations to maintain records of certain third party payments for prescription drugs; providing reporting requirements; providing requirements for the reports; providing applicability; amending s. 641.314, F.S.; requiring that specified contracts require pharmacy benefit managers to apply payments by or on behalf of subscribers toward the subscribers’ total contributions to cost-sharing requirements; providing applicability; providing disclosure requirements relating to a subscriber’s total cost-sharing requirement for prescription drugs; amending s. 409.967, F.S.; conforming a cross-reference; amending s. 641.185, F.S.; conforming a provision to changes made by the act; providing applicability; providing a declaration of important state interest; providing an effective date.

AI Summary

Ana Maria Rodriguez (R)*, 

Introduced (on 01/13/2026)

Official Document