Bill Text: FL S1180 | 2019 | Regular Session | Engrossed


Bill Title: Prescription Drug Formulary Consumer Protection

Spectrum: Bipartisan Bill

Status: (Failed) 2019-05-03 - Died in Messages [S1180 Detail]

Download: Florida-2019-S1180-Engrossed.html
       CS for CS for CS for SB 1180                     First Engrossed
       
       
       
       
       
       
       
       
       20191180e1
       
    1                        A bill to be entitled                      
    2         An act relating to prescription drug formulary
    3         consumer protection; creating s. 627.42393, F.S.;
    4         requiring insurers issuing individual or group health
    5         insurance policies to provide certain notices to
    6         current and prospective insureds, and the insureds’
    7         treating physicians, within a certain timeframe before
    8         the effective date of any change to a prescription
    9         drug formulary during a policy year; requiring such
   10         insurers to maintain a record of formulary changes and
   11         submit a certain annual report to the Office of
   12         Insurance Regulation; specifying requirements for the
   13         annual report; requiring the office to annually
   14         compile data in such reports and prepare an annual
   15         report summarizing such data; requiring the office to
   16         annually post the report on its website and submit the
   17         report to the Governor and Legislature by a certain
   18         date; amending s. 627.6699, F.S.; requiring small
   19         employer carriers to comply with certain requirements
   20         for any change to a prescription drug formulary under
   21         the health benefit plan; amending s. 641.31, F.S.;
   22         requiring health maintenance organizations to provide
   23         certain notices to current and prospective
   24         subscribers, and the subscribers’ treating physicians,
   25         within a certain timeframe before the effective date
   26         of any change to a prescription drug formulary during
   27         a contract year; requiring such health maintenance
   28         organizations to maintain a record of formulary
   29         changes and submit a certain annual report to the
   30         office; specifying requirements for the annual report;
   31         requiring the office to annually compile data in such
   32         reports and prepare an annual report summarizing such
   33         data; requiring the office to annually post the report
   34         on its website and submit the report to the Governor
   35         and Legislature; providing a declaration of important
   36         state interest; providing an effective date.
   37          
   38  Be It Enacted by the Legislature of the State of Florida:
   39  
   40         Section 1. Section 627.42393, Florida Statutes, is created
   41  to read:
   42         627.42393Health insurance policies; changes to
   43  prescription drug formularies; requirements.—
   44         (1)At least 60 days before the effective date of any
   45  change to a prescription drug formulary during a policy year, an
   46  insurer issuing individual or group health insurance policies in
   47  this state shall provide general notification of the change in
   48  the formulary to current and prospective insureds in a readily
   49  accessible format on the insurer’s website and notify,
   50  electronically or by first-class mail, any insured currently
   51  receiving coverage for a prescription drug for which the
   52  formulary change modifies coverage and the insured’s treating
   53  physician, including information on the specific drugs involved.
   54         (2) A health insurer shall maintain a record of any change
   55  in its formulary during a calendar year. By March 1 annually, a
   56  health insurer shall submit a report to the office delineating
   57  such changes made in the previous calendar year. The annual
   58  report must include, at a minimum:
   59         (a) A list of all drugs that were removed from a formulary
   60  and the reasons for the removal;
   61         (b) A list of all drugs that were moved to a tier that
   62  resulted in additional out-of-pocket costs to insureds;
   63         (c) The number of insureds notified by the insurer of a
   64  change in formulary; and
   65         (d) The increased cost, by dollar amount, incurred by
   66  insureds because of such change in the formulary.
   67         (3) By May 1 annually, the office shall:
   68         (a) Compile the data in such annual reports submitted by
   69  health insurers and prepare a report summarizing the data
   70  submitted;
   71         (b) Make the report publicly accessible on its website; and
   72         (c) Submit the report to the Governor, the President of the
   73  Senate, and the Speaker of the House of Representatives.
   74         Section 2. Paragraph (e) of subsection (5) of section
   75  627.6699, Florida Statutes, is amended to read:
   76         627.6699 Employee Health Care Access Act.—
   77         (5) AVAILABILITY OF COVERAGE.—
   78         (e) All health benefit plans issued under this section must
   79  comply with the following conditions:
   80         1. For employers who have fewer than two employees, a late
   81  enrollee may be excluded from coverage for no longer than 24
   82  months if he or she was not covered by creditable coverage
   83  continually to a date not more than 63 days before the effective
   84  date of his or her new coverage.
   85         2. Any requirement used by a small employer carrier in
   86  determining whether to provide coverage to a small employer
   87  group, including requirements for minimum participation of
   88  eligible employees and minimum employer contributions, must be
   89  applied uniformly among all small employer groups having the
   90  same number of eligible employees applying for coverage or
   91  receiving coverage from the small employer carrier, except that
   92  a small employer carrier that participates in, administers, or
   93  issues health benefits pursuant to s. 381.0406 which do not
   94  include a preexisting condition exclusion may require as a
   95  condition of offering such benefits that the employer has had no
   96  health insurance coverage for its employees for a period of at
   97  least 6 months. A small employer carrier may vary application of
   98  minimum participation requirements and minimum employer
   99  contribution requirements only by the size of the small employer
  100  group.
  101         3. In applying minimum participation requirements with
  102  respect to a small employer, a small employer carrier shall not
  103  consider as an eligible employee employees or dependents who
  104  have qualifying existing coverage in an employer-based group
  105  insurance plan or an ERISA qualified self-insurance plan in
  106  determining whether the applicable percentage of participation
  107  is met. However, a small employer carrier may count eligible
  108  employees and dependents who have coverage under another health
  109  plan that is sponsored by that employer.
  110         4. A small employer carrier shall not increase any
  111  requirement for minimum employee participation or any
  112  requirement for minimum employer contribution applicable to a
  113  small employer at any time after the small employer has been
  114  accepted for coverage, unless the employer size has changed, in
  115  which case the small employer carrier may apply the requirements
  116  that are applicable to the new group size.
  117         5. If a small employer carrier offers coverage to a small
  118  employer, it must offer coverage to all the small employer’s
  119  eligible employees and their dependents. A small employer
  120  carrier may not offer coverage limited to certain persons in a
  121  group or to part of a group, except with respect to late
  122  enrollees.
  123         6. A small employer carrier may not modify any health
  124  benefit plan issued to a small employer with respect to a small
  125  employer or any eligible employee or dependent through riders,
  126  endorsements, or otherwise to restrict or exclude coverage for
  127  certain diseases or medical conditions otherwise covered by the
  128  health benefit plan.
  129         7. An initial enrollment period of at least 30 days must be
  130  provided. An annual 30-day open enrollment period must be
  131  offered to each small employer’s eligible employees and their
  132  dependents. A small employer carrier must provide special
  133  enrollment periods as required by s. 627.65615.
  134         8. A small employer carrier shall comply with s. 627.42393
  135  for any change to a prescription drug formulary.
  136         Section 3. Subsection (36) of section 641.31, Florida
  137  Statutes, is amended to read:
  138         641.31 Health maintenance contracts.—
  139         (36) Except as provided in paragraph (a), a health
  140  maintenance organization may increase the copayment for any
  141  benefit, or delete, amend, or limit any of the benefits to which
  142  a subscriber is entitled under the group contract only, upon
  143  written notice to the contract holder at least 45 days in
  144  advance of the time of coverage renewal. The health maintenance
  145  organization may amend the contract with the contract holder,
  146  with such amendment to be effective immediately at the time of
  147  coverage renewal. The written notice to the contract holder must
  148  shall specifically identify any deletions, amendments, or
  149  limitations to any of the benefits provided in the group
  150  contract during the current contract period which will be
  151  included in the group contract upon renewal. This subsection
  152  does not apply to any increases in benefits. The 45-day notice
  153  requirement does shall not apply if benefits are amended,
  154  deleted, or limited at the request of the contract holder.
  155         (a) At least 60 days before the effective date of any
  156  change to a prescription drug formulary during a contract year,
  157  the health maintenance organization shall provide general
  158  notification of the change in the formulary to current and
  159  prospective subscribers in a readily accessible format on the
  160  health maintenance organization’s website and notify,
  161  electronically or by first-class mail, any subscriber currently
  162  receiving coverage for a prescription drug for which the
  163  formulary change modifies coverage and the subscriber’s treating
  164  physician, including information on the specific drugs involved.
  165         (b) A health maintenance organization shall maintain a
  166  record of any change in its formulary during a calendar year. By
  167  March 1 annually, a health maintenance organization shall submit
  168  a report to the office delineating such changes made in the
  169  previous calendar year. The annual report must include, at a
  170  minimum:
  171         1. A list of all drugs that were removed from a formulary
  172  and the reasons for the removal;
  173         2. A list of all drugs that were moved to a tier that
  174  resulted in additional out-of-pocket costs to subscribers;
  175         3. The number of subscribers notified by the health
  176  maintenance organization of a change in formulary; and
  177         4. The increased cost, by dollar amount, incurred by
  178  subscribers because of such change in the formulary.
  179         (c) By May 1 annually, the office shall:
  180         1. Compile the data in such annual reports submitted by
  181  health maintenance organizations and prepare a report
  182  summarizing the data submitted;
  183         2. Make the report publicly accessible on its website; and
  184         3. Submit the report to the Governor, the President of the
  185  Senate, and the Speaker of the House of Representatives.
  186         Section 4. The Legislature finds that this act fulfills an
  187  important state interest.
  188         Section 5. This act shall take effect January 1, 2020.

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