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:
42 627.42393 Health 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.
