Bill Text: FL S0860 | 2015 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

---

Bill Title: Pharmacy

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Failed) 2015-05-01 - Died in Appropriations, companion bill(s) passed, see CS/CS/HB 1049 (Ch. 2015-127) [S0860 Detail]

Download: Florida-2015-S0860-Introduced.html

---

       Florida Senate - 2015                                     SB 860
       
       
        
       By Senator Garcia
       
       
       
       
       
       38-00409-15                                            2015860__
    1                        A bill to be entitled                      
    2         An act relating to pharmacy; creating s. 465.1862,
    3         F.S.; defining terms; providing requirements for
    4         contracts between pharmacy benefit managers and
    5         contracted pharmacies; requiring a pharmacy benefit
    6         manager to ensure that a prescription drug has met
    7         certain requirements to be placed on a maximum
    8         allowable cost pricing list; requiring the pharmacy
    9         benefit manager to disclose certain information to a
   10         plan sponsor; requiring a contract between a pharmacy
   11         benefit manager and a pharmacy to include an appeal
   12         process; providing an effective date.
   13          
   14  Be It Enacted by the Legislature of the State of Florida:
   15  
   16         Section 1. Section 465.1862, Florida Statutes, is created
   17  to read:
   18         465.1862 Pharmacy benefit managers.—
   19         (1) As used in this section, the term:
   20         (a) “Contracted pharmacy” means a pharmacy or network of
   21  pharmacies that has executed a contract, which includes maximum
   22  allowable cost pricing requirements, with a pharmacy benefit
   23  manager and acts on behalf of a plan sponsor.
   24         (b) “Maximum allowable cost” means the upper limit or
   25  maximum amount that an insurer or managed care plan will pay for
   26  generic prescription drugs or brand-name prescription drugs with
   27  available generic versions, which are included on a list of
   28  products generated by the pharmacy benefit manager.
   29         (c) “Pharmacy benefit manager” means a person, business, or
   30  other entity that provides administrative services related to
   31  processing and paying prescription claims for pharmacy benefit
   32  and coverage programs. Such services may include, but are not
   33  limited to, contracting with a pharmacy or network of
   34  pharmacies; establishing payment levels for pharmacies;
   35  dispensing prescription drugs to plan sponsor beneficiaries;
   36  negotiating discounts and rebate arrangements with drug
   37  manufacturers; developing and managing prescription formularies,
   38  preferred drug lists, and prior authorization programs; ensuring
   39  audit compliance; and providing management reports.
   40         (d) “Plan sponsor” means an employer, insurer, managed care
   41  organization, prepaid limited health service organization,
   42  third-party administrator, or other entity contracting for
   43  pharmacy benefit manager services.
   44         (2) A contract between a pharmacy benefit manager and a
   45  contracted pharmacy must require the pharmacy benefit manager
   46  to:
   47         (a) Update the maximum allowable cost pricing information
   48  at least every 7 calendar days and establish a reasonable
   49  process for the prompt notification of any pricing updates to
   50  the contracted pharmacy.
   51         (b) Maintain a procedure to remain consistent with pricing
   52  changes in the marketplace by promptly modifying the maximum
   53  allowable cost pricing information or, if necessary, eliminating
   54  products from the cost pricing list within 3 calendar days after
   55  a change if such products no longer meet the requirements of
   56  this section.
   57         (3) A pharmacy benefit manager, to place a prescription
   58  drug on a maximum allowable cost pricing list, at a minimum,
   59  must ensure that the drug has at least three or more nationally
   60  available, therapeutically equivalent, multiple-source generic
   61  drugs that:
   62         (a) Have a significant cost difference.
   63         (b) Are listed as therapeutically and pharmaceutically
   64  equivalent or “A” or “B” rated in the most recent version of
   65  Orange Book: Approved Drug Products with Therapeutic Equivalence
   66  Evaluations published by the United States Food and Drug
   67  Administration.
   68         (c) Are available for purchase from national or regional
   69  wholesalers without limitation by all pharmacies in the state.
   70         (d) Are not obsolete or temporarily unavailable.
   71         (4) In a contract between a pharmacy benefit manager and a
   72  plan sponsor, the pharmacy benefit manager must disclose the
   73  following to the plan sponsor:
   74         (a) The basis of the methodology and sources used to
   75  establish applicable maximum allowable cost pricing. A pharmacy
   76  benefit manager shall promptly update applicable maximum
   77  allowable cost pricing lists and provide the plan sponsor with
   78  an updated list upon any pricing change.
   79         (b) Whether the pharmacy benefit manager uses a maximum
   80  allowable cost pricing list for drugs dispensed at retail but
   81  does not use such a list for drugs dispensed by mail order. If
   82  such practice is adopted after a contract is executed, the
   83  pharmacy benefit manager shall disclose such practice to the
   84  plan sponsor within 21 business days after implementation of the
   85  practice.
   86         (c) Whether the pharmacy benefit manager uses an identical
   87  maximum allowable cost pricing list to bill the plan sponsor and
   88  to reimburse a contracted pharmacy. If more than one maximum
   89  allowable cost pricing list is used, the pharmacy benefit
   90  manager shall disclose to the contracted pharmacy any difference
   91  between the amount billed to the plan sponsor and the amount
   92  paid as reimbursement to a contracted pharmacy.
   93         (5)(a) Each contract between a pharmacy benefit manager and
   94  a contracted pharmacy must include a process for appeal,
   95  investigation, and resolution of disputes regarding maximum
   96  allowable cost pricing. The process must:
   97         1. Limit the right to appeal to 90 calendar days after an
   98  initial claim is made by the contracted pharmacy.
   99         2. Require investigation and resolution of a dispute within
  100  7 days after an appeal is received by the pharmacy benefit
  101  manager.
  102         3. Include a telephone number at which a contracted
  103  pharmacy may contact the pharmacy benefit manager regarding an
  104  appeal.
  105         (b) If an appeal is denied, the pharmacy benefit manager
  106  shall provide the reasons for denial and shall identify the
  107  national drug code for the prescription drug that may be
  108  purchased by the contracted pharmacy at a price at or below the
  109  disputed maximum allowable cost pricing.
  110         (c) If an appeal is upheld, the pharmacy benefit manager
  111  shall adjust the maximum allowable cost pricing retroactive to
  112  the date that the claim was adjudicated. The pharmacy benefit
  113  manager shall apply the adjustment retroactively to any
  114  similarly situated contracted pharmacy.
  115         Section 2. This act shall take effect July 1, 2015.