Bill Text: FL S1494 | 2018 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Prescription Drug Pricing Transparency

Spectrum:

Status: (Introduced - Dead) 2018-03-07 - Laid on Table, refer to CS/CS/HB 351 [S1494 Detail]

Download: Florida-2018-S1494-Introduced.html
       Florida Senate - 2018                                    SB 1494
       
       
        
       By Senator Montford
       
       
       
       
       
       3-00778D-18                                           20181494__
    1                        A bill to be entitled                      
    2         An act relating to prescription drug pricing
    3         transparency; amending s. 465.0244, F.S.; requiring a
    4         pharmacist to inform a customer of a lower cost
    5         alternative to a prescription and of whether the
    6         customer’s cost-sharing obligation exceeds the retail
    7         price of the prescription; creating s. 624.49, F.S.;
    8         defining the term “pharmacy benefit manager”;
    9         requiring a pharmacy benefit manager to register with
   10         the Office of Insurance Regulation; providing
   11         requirements and terms of registration, including the
   12         payment of a registration fee; requiring the office to
   13         issue certificates of registration and to set an
   14         initial registration fee and a renewal fee; requiring
   15         the office to adopt rules; creating ss. 627.64741 and
   16         641.314, F.S.; defining the terms “maximum allowable
   17         cost” and “pharmacy benefit manager”; requiring that
   18         certain terms be included in a contract between a
   19         health insurer or a health maintenance organization
   20         and a pharmacy benefit manager, respectively;
   21         providing applicability; providing an effective date.
   22          
   23  Be It Enacted by the Legislature of the State of Florida:
   24  
   25         Section 1. Section 465.0244, Florida Statutes, is amended
   26  to read:
   27         465.0244 Information disclosure.—
   28         (1) Every pharmacy shall make available on its website a
   29  hyperlink to the health information that is disseminated by the
   30  Agency for Health Care Administration pursuant to s. 408.05(3)
   31  and shall place in the area where customers receive filled
   32  prescriptions a notice that such information is available
   33  electronically and the address of its Internet website.
   34         (2) In addition to the requirements of s. 465.025, a
   35  pharmacist must inform a customer of a lower cost alternative
   36  for his or her prescription and of whether the customer’s cost
   37  sharing obligation exceeds the retail price of the prescription
   38  in the absence of prescription drug coverage.
   39         Section 2. Section 624.49, Florida Statutes, is created to
   40  read:
   41         624.49 Registration of pharmacy benefit managers.—
   42         (1) As used in this section, “pharmacy benefit manager”
   43  means a person or entity doing business in this state which
   44  contracts to administer prescription drug benefits on behalf of
   45  a health insurer or a health maintenance organization.
   46         (2) To conduct business in this state, a pharmacy benefit
   47  manager must register with the Office of Insurance Regulation.
   48  To register, a pharmacy benefit manager must submit a fee
   49  determined by the office, a copy of the registrant’s corporate
   50  charter, articles of incorporation, or other charter document,
   51  and a form established by the office containing the identity,
   52  address, and either the social security number or taxpayer
   53  identification number of all of the following persons:
   54         (a) The registrant;
   55         (b) The chief executive officer or a similarly titled
   56  person responsible for the executive oversight of the
   57  registrant;
   58         (c) The chief financial officer or a similarly titled
   59  person responsible for the financial oversight of the
   60  registrant; and
   61         (d) Each controlling interest of the registrant. For the
   62  purpose of this section, “controlling interest” means a person
   63  or entity that serves as an officer of, is on the board of
   64  directors of, or has a 10 percent or greater ownership interest
   65  in the registrant.
   66         (3) The registrant shall report a change in any controlling
   67  interest of the registrant to the office in writing within 30
   68  days after the change.
   69         (4) Upon receipt of a complete registration form and the
   70  registration fee, the office shall issue a registration
   71  certificate. The certificate may be in paper or electronic form,
   72  and must clearly indicate the expiration date of the
   73  registration. Registration certificates are nontransferable.
   74         (5)(a) The term of registration shall be 2 years from the
   75  date of issuance.
   76         (b) The office shall set an initial registration fee and a
   77  renewal fee, which are nonrefundable. Total fees may not exceed
   78  the cost of administering this section.
   79         (6) The office shall adopt rules necessary to administer
   80  this section.
   81         Section 3. Section 627.64741, Florida Statutes, is created
   82  to read:
   83         627.64741 Pharmacy benefit manager contracts.—
   84         (1) As used in this section, the term:
   85         (a) “Maximum allowable cost” means the per-unit amount that
   86  a pharmacy benefit manager may reimburse a pharmacist for a
   87  prescription drug, excluding dispensing fees, before the
   88  application of copayments, coinsurance, or any other cost
   89  sharing charges.
   90         (b) “Pharmacy benefit manager” means a person or entity
   91  doing business in this state which contracts to administer or
   92  manage prescription drug benefits on behalf of a health insurer
   93  to residents of this state.
   94         (2) A contract between a health insurer and a pharmacy
   95  benefit manager must include requirements that the pharmacy
   96  benefit manager:
   97         (a) Update maximum allowable cost information at least
   98  every 7 calendar days; and
   99         (b) Maintain a process that will, in a timely manner,
  100  eliminate drugs from maximum allowable cost lists or modify drug
  101  prices to remain consistent with changes in pricing data used in
  102  formulating maximum allowable costs and product availability.
  103         (3) A contract between a health insurer and a pharmacy
  104  benefit manager must prohibit the pharmacy benefit manager from
  105  limiting a pharmacy’s or pharmacist’s ability to substitute a
  106  less expensive, generically equivalent drug product for a brand
  107  name drug, pursuant to s. 465.025, or to disclose to a
  108  subscriber whether the subscriber’s cost-sharing obligation
  109  exceeds the retail price for a covered prescription drug, and
  110  the availability of a more affordable alternative drug, pursuant
  111  to s. 465.0244.
  112         (4) A contract between a health insurer and a pharmacy
  113  benefit manager must prohibit the pharmacy benefit manager from
  114  requiring a subscriber to pay for a prescription drug at the
  115  point of sale in an amount greater than the lesser of:
  116         (a) The applicable cost-sharing amount;
  117         (b) The allowable claim amount for the prescription drug;
  118  and
  119         (c) The retail price of the drug in the absence of
  120  prescription drug coverage or programs that otherwise reduce the
  121  cost of a drug to the patient.
  122         (5) This section applies to contracts entered into or
  123  renewed on or after July 1, 2018.
  124         Section 4. Section 641.314, Florida Statutes, is created to
  125  read:
  126         641.314 Pharmacy benefit manager contracts.—
  127         (1) As used in this section, the term:
  128         (a) “Maximum allowable cost” means the per-unit amount that
  129  a pharmacy benefit manager reimburses a pharmacist for a
  130  prescription drug, excluding dispensing fees, before the
  131  application of copayments, coinsurance, or any other cost
  132  sharing charges.
  133         (b) “Pharmacy benefit manager” means a person or entity
  134  doing business in this state which contracts to administer or
  135  manage prescription drug benefits on behalf of a health
  136  maintenance organization to residents of this state.
  137         (2) A contract between a health maintenance organization
  138  and a pharmacy benefit manager must include requirements that
  139  the pharmacy benefit manager:
  140         (a) Update maximum allowable cost information at least
  141  every 7 calendar days; and
  142         (b) Maintain a process that will, in a timely manner,
  143  eliminate drugs from maximum allowable cost lists or modify drug
  144  prices to remain consistent with changes in pricing data used in
  145  formulating maximum allowable costs and product availability.
  146         (3) A contract between a health maintenance organization
  147  and a pharmacy benefit manager must prohibit the pharmacy
  148  benefit manager from limiting a pharmacy’s or pharmacist’s
  149  ability to substitute a less expensive, generically equivalent
  150  drug product for a brand name drug, pursuant to s. 465.025, or
  151  to disclose to a subscriber whether the subscriber’s cost
  152  sharing obligation exceeds the retail price for a covered
  153  prescription drug, and the availability of a more affordable
  154  alternative drug, pursuant to s. 465.0244.
  155         (4) A contract between a health maintenance organization
  156  and a pharmacy benefit manager must prohibit the pharmacy
  157  benefit manager from requiring a subscriber to pay for a
  158  prescription drug at the point of sale in an amount greater than
  159  the lesser of:
  160         (a) The applicable cost-sharing amount;
  161         (b) The allowable claim amount for the prescription drug;
  162  and
  163         (c) The retail price of the drug in the absence of
  164  prescription drug coverage or programs that otherwise reduce the
  165  cost of a drug to the patient.
  166         (5) This section applies to contracts entered into or
  167  renewed on or after July 1, 2018.
  168         Section 5. This act shall take effect July 1, 2018.

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