Bill Text: FL S0360 | 2018 | Regular Session | Introduced


Bill Title: Consumer Protection from Nonmedical Changes to Prescription Drug Formularies

Spectrum: Bipartisan Bill

Status: (Introduced) 2018-01-09 - Introduced [S0360 Detail]

Download: Florida-2018-S0360-Introduced.html
       Florida Senate - 2018                                     SB 360
       
       
        
       By Senator Mayfield
       
       
       
       
       
       17-00425-18                                            2018360__
    1                        A bill to be entitled                      
    2         An act relating to consumer protection from nonmedical
    3         changes to prescription drug formularies; creating s.
    4         627.42393, F.S.; prohibiting specified changes to
    5         certain insurance policy prescription drug
    6         formularies, except under certain circumstances;
    7         providing construction and applicability; amending s.
    8         627.6699, F.S.; requiring small employer carriers to
    9         limit specified changes to prescription drug
   10         formularies under certain health benefit plans;
   11         amending s. 641.31, F.S.; prohibiting certain health
   12         maintenance organizations from making specified
   13         changes to health maintenance contract prescription
   14         drug formularies, except under certain circumstances;
   15         providing construction and applicability; providing a
   16         declaration of important state interest; providing an
   17         effective date.
   18          
   19  Be It Enacted by the Legislature of the State of Florida:
   20  
   21         Section 1. Section 627.42393, Florida Statutes, is created
   22  to read:
   23         627.42393Insurance policies; limiting changes to
   24  prescription drug formularies.—
   25         (1)Other than at the time of coverage renewal, an
   26  individual or group insurance policy that is delivered, issued
   27  for delivery, renewed, amended, or continued in this state and
   28  that provides medical, major medical, or similar comprehensive
   29  coverage may not:
   30         (a)Remove a covered prescription drug from its list of
   31  covered drugs during the policy year unless the United States
   32  Food and Drug Administration has issued a statement about the
   33  drug which calls into question the clinical safety of the drug,
   34  or the manufacturer of the drug has notified the United States
   35  Food and Drug Administration of a manufacturing discontinuance
   36  or potential discontinuance of the drug as required by s. 506C
   37  of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
   38         (b)Reclassify a drug to a more restrictive drug tier or
   39  increase the amount that an insured must pay for a copayment,
   40  coinsurance, or deductible for prescription drug benefits, or
   41  reclassify a drug to a higher cost-sharing tier during the
   42  policy year.
   43         (2)This section does not prohibit the addition of
   44  prescription drugs to the list of drugs covered under the policy
   45  during the policy year.
   46         (3)This section does not apply to a grandfathered health
   47  plan as defined in s. 627.402 or to benefits set forth in s.
   48  627.6513(1)-(14).
   49         (4)This section does not alter or amend s. 465.025, which
   50  provides conditions under which a pharmacist may substitute a
   51  generically equivalent drug product for a brand name drug
   52  product.
   53         (5)This section does not alter or amend s. 465.0252, which
   54  provides conditions under which a pharmacist may dispense a
   55  substitute biological product for the prescribed biological
   56  product.
   57         Section 2. Paragraph (e) of subsection (5) of section
   58  627.6699, Florida Statutes, is amended to read:
   59         627.6699 Employee Health Care Access Act.—
   60         (5) AVAILABILITY OF COVERAGE.—
   61         (e) All health benefit plans issued under this section must
   62  comply with the following conditions:
   63         1. For employers who have fewer than two employees, a late
   64  enrollee may be excluded from coverage for no longer than 24
   65  months if he or she was not covered by creditable coverage
   66  continually to a date not more than 63 days before the effective
   67  date of his or her new coverage.
   68         2. Any requirement used by a small employer carrier in
   69  determining whether to provide coverage to a small employer
   70  group, including requirements for minimum participation of
   71  eligible employees and minimum employer contributions, must be
   72  applied uniformly among all small employer groups having the
   73  same number of eligible employees applying for coverage or
   74  receiving coverage from the small employer carrier, except that
   75  a small employer carrier that participates in, administers, or
   76  issues health benefits pursuant to s. 381.0406 which do not
   77  include a preexisting condition exclusion may require as a
   78  condition of offering such benefits that the employer has had no
   79  health insurance coverage for its employees for a period of at
   80  least 6 months. A small employer carrier may vary application of
   81  minimum participation requirements and minimum employer
   82  contribution requirements only by the size of the small employer
   83  group.
   84         3. In applying minimum participation requirements with
   85  respect to a small employer, a small employer carrier shall not
   86  consider as an eligible employee employees or dependents who
   87  have qualifying existing coverage in an employer-based group
   88  insurance plan or an ERISA qualified self-insurance plan in
   89  determining whether the applicable percentage of participation
   90  is met. However, a small employer carrier may count eligible
   91  employees and dependents who have coverage under another health
   92  plan that is sponsored by that employer.
   93         4. A small employer carrier shall not increase any
   94  requirement for minimum employee participation or any
   95  requirement for minimum employer contribution applicable to a
   96  small employer at any time after the small employer has been
   97  accepted for coverage, unless the employer size has changed, in
   98  which case the small employer carrier may apply the requirements
   99  that are applicable to the new group size.
  100         5. If a small employer carrier offers coverage to a small
  101  employer, it must offer coverage to all the small employer’s
  102  eligible employees and their dependents. A small employer
  103  carrier may not offer coverage limited to certain persons in a
  104  group or to part of a group, except with respect to late
  105  enrollees.
  106         6. A small employer carrier may not modify any health
  107  benefit plan issued to a small employer with respect to a small
  108  employer or any eligible employee or dependent through riders,
  109  endorsements, or otherwise to restrict or exclude coverage for
  110  certain diseases or medical conditions otherwise covered by the
  111  health benefit plan.
  112         7. An initial enrollment period of at least 30 days must be
  113  provided. An annual 30-day open enrollment period must be
  114  offered to each small employer’s eligible employees and their
  115  dependents. A small employer carrier must provide special
  116  enrollment periods as required by s. 627.65615.
  117         8. A small employer carrier must limit changes to
  118  prescription drug formularies as required by s. 627.42393.
  119         Section 3. Subsection (36) of section 641.31, Florida
  120  Statutes, is amended to read:
  121         641.31 Health maintenance contracts.—
  122         (36) A health maintenance organization may increase the
  123  copayment for any benefit, or delete, amend, or limit any of the
  124  benefits to which a subscriber is entitled under the group
  125  contract only, upon written notice to the contract holder at
  126  least 45 days in advance of the time of coverage renewal. The
  127  health maintenance organization may amend the contract with the
  128  contract holder, with such amendment to be effective immediately
  129  at the time of coverage renewal. The written notice to the
  130  contract holder must shall specifically identify any deletions,
  131  amendments, or limitations to any of the benefits provided in
  132  the group contract during the current contract period which will
  133  be included in the group contract upon renewal. This subsection
  134  does not apply to any increases in benefits. The 45-day notice
  135  requirement does shall not apply if benefits are amended,
  136  deleted, or limited at the request of the contract holder.
  137         (a) Other than at the time of coverage renewal, a health
  138  maintenance organization that provides medical, major medical,
  139  or similar comprehensive coverage may not:
  140         1. Remove a covered prescription drug from its list of
  141  covered drugs during the contract year unless the United States
  142  Food and Drug Administration has issued a statement about the
  143  drug which calls into question the clinical safety of the drug,
  144  or the manufacturer of the drug has notified the United States
  145  Food and Drug Administration of a manufacturing discontinuance
  146  or potential discontinuance of the drug as required by s. 506C
  147  of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
  148         2. Reclassify a drug to a more restrictive drug tier or
  149  increase the amount that an insured must pay for a copayment,
  150  coinsurance, or deductible for prescription drug benefits, or
  151  reclassify a drug to a higher cost-sharing tier during the
  152  contract year.
  153         (b) This subsection does not:
  154         1. Prohibit the addition of prescription drugs to the list
  155  of drugs covered during the contract year.
  156         2. Apply to a grandfathered health plan as defined in s.
  157  627.402 or to benefits set forth in s. 627.6513(1)-(14).
  158         3. Alter or amend s. 465.025, which provides conditions
  159  under which a pharmacist may substitute a generically equivalent
  160  drug product for a brand name drug product.
  161         4. Alter or amend s. 465.0252, which provides conditions
  162  under which a pharmacist may dispense a substitute biological
  163  product for the prescribed biological product.
  164         Section 4. The Legislature finds that this act fulfills an
  165  important state interest.
  166         Section 5. This act shall take effect January 1, 2019.

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