Florida Senate - 2017                          SENATOR AMENDMENT
       Bill No. CS for HB 161
       
       
       
       
       
       
                                Ì898364IÎ898364                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                 Floor: WD/2R          .                                
             05/04/2017 08:30 PM       .                                
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       Senator Mayfield moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete line 82
    4  and insert:
    5         Section 2. Effective January 1, 2018, section 627.42393,
    6  Florida Statutes, is created to read:
    7         627.42393Insurance policies; limiting changes to
    8  prescription drug formularies.—
    9         (1)Other than at the time of coverage renewal, an
   10  individual or group insurance policy that is delivered, issued
   11  for delivery, renewed, amended, or continued in this state and
   12  that provides medical, major medical, or similar comprehensive
   13  coverage may not:
   14         (a)Remove a covered prescription drug from its list of
   15  covered drugs during the policy year unless the United States
   16  Food and Drug Administration has issued a statement about the
   17  drug which calls into question the clinical safety of the drug,
   18  or the manufacturer of the drug has notified the United States
   19  Food and Drug Administration of a manufacturing discontinuance
   20  or potential discontinuance of the drug as required by s. 506C
   21  of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
   22         (b)Reclassify a drug to a more restrictive drug tier or
   23  increase the amount that an insured must pay for a copayment,
   24  coinsurance, or deductible for prescription drug benefits, or
   25  reclassify a drug to a higher cost-sharing tier during the
   26  policy year.
   27         (2)This section does not prohibit the addition of
   28  prescription drugs to the list of drugs covered under the policy
   29  during the policy year.
   30         (3)This section does not apply to a grandfathered health
   31  plan as defined in s. 627.402 or to benefits set forth in s.
   32  627.6513(1)-(14).
   33         (4)This section does not alter or amend s. 465.025, which
   34  provides conditions under which a pharmacist may substitute a
   35  generically equivalent drug product for a brand name drug
   36  product.
   37         (5)This section does not alter or amend s. 465.0252, which
   38  provides conditions under which a pharmacist may dispense a
   39  substitute biological product for the prescribed biological
   40  product.
   41         Section 3. Effective January 1, 2018, Paragraph (e) of
   42  subsection (5) of section 627.6699, Florida Statutes, is amended
   43  to read:
   44         627.6699 Employee Health Care Access Act.—
   45         (5) AVAILABILITY OF COVERAGE.—
   46         (e) All health benefit plans issued under this section must
   47  comply with the following conditions:
   48         1. For employers who have fewer than two employees, a late
   49  enrollee may be excluded from coverage for no longer than 24
   50  months if he or she was not covered by creditable coverage
   51  continually to a date not more than 63 days before the effective
   52  date of his or her new coverage.
   53         2. Any requirement used by a small employer carrier in
   54  determining whether to provide coverage to a small employer
   55  group, including requirements for minimum participation of
   56  eligible employees and minimum employer contributions, must be
   57  applied uniformly among all small employer groups having the
   58  same number of eligible employees applying for coverage or
   59  receiving coverage from the small employer carrier, except that
   60  a small employer carrier that participates in, administers, or
   61  issues health benefits pursuant to s. 381.0406 which do not
   62  include a preexisting condition exclusion may require as a
   63  condition of offering such benefits that the employer has had no
   64  health insurance coverage for its employees for a period of at
   65  least 6 months. A small employer carrier may vary application of
   66  minimum participation requirements and minimum employer
   67  contribution requirements only by the size of the small employer
   68  group.
   69         3. In applying minimum participation requirements with
   70  respect to a small employer, a small employer carrier shall not
   71  consider as an eligible employee employees or dependents who
   72  have qualifying existing coverage in an employer-based group
   73  insurance plan or an ERISA qualified self-insurance plan in
   74  determining whether the applicable percentage of participation
   75  is met. However, a small employer carrier may count eligible
   76  employees and dependents who have coverage under another health
   77  plan that is sponsored by that employer.
   78         4. A small employer carrier shall not increase any
   79  requirement for minimum employee participation or any
   80  requirement for minimum employer contribution applicable to a
   81  small employer at any time after the small employer has been
   82  accepted for coverage, unless the employer size has changed, in
   83  which case the small employer carrier may apply the requirements
   84  that are applicable to the new group size.
   85         5. If a small employer carrier offers coverage to a small
   86  employer, it must offer coverage to all the small employer’s
   87  eligible employees and their dependents. A small employer
   88  carrier may not offer coverage limited to certain persons in a
   89  group or to part of a group, except with respect to late
   90  enrollees.
   91         6. A small employer carrier may not modify any health
   92  benefit plan issued to a small employer with respect to a small
   93  employer or any eligible employee or dependent through riders,
   94  endorsements, or otherwise to restrict or exclude coverage for
   95  certain diseases or medical conditions otherwise covered by the
   96  health benefit plan.
   97         7. An initial enrollment period of at least 30 days must be
   98  provided. An annual 30-day open enrollment period must be
   99  offered to each small employer’s eligible employees and their
  100  dependents. A small employer carrier must provide special
  101  enrollment periods as required by s. 627.65615.
  102         8. A small employer carrier must limit changes to
  103  prescription drug formularies as required by s. 627.42393.
  104         Section 4. Effective January 1, 2018, subsection (36) of
  105  section 641.31, Florida Statutes, is amended to read:
  106         641.31 Health maintenance contracts.—
  107         (36) A health maintenance organization may increase the
  108  copayment for any benefit, or delete, amend, or limit any of the
  109  benefits to which a subscriber is entitled under the group
  110  contract only, upon written notice to the contract holder at
  111  least 45 days in advance of the time of coverage renewal. The
  112  health maintenance organization may amend the contract with the
  113  contract holder, with such amendment to be effective immediately
  114  at the time of coverage renewal. The written notice to the
  115  contract holder must shall specifically identify any deletions,
  116  amendments, or limitations to any of the benefits provided in
  117  the group contract during the current contract period which will
  118  be included in the group contract upon renewal. This subsection
  119  does not apply to any increases in benefits. The 45-day notice
  120  requirement does shall not apply if benefits are amended,
  121  deleted, or limited at the request of the contract holder.
  122         (a) Other than at the time of coverage renewal, a health
  123  maintenance organization that provides medical, major medical,
  124  or similar comprehensive coverage may not:
  125         1. Remove a covered prescription drug from its list of
  126  covered drugs during the contract year unless the United States
  127  Food and Drug Administration has issued a statement about the
  128  drug which calls into question the clinical safety of the drug,
  129  or the manufacturer of the drug has notified the United States
  130  Food and Drug Administration of a manufacturing discontinuance
  131  or potential discontinuance of the drug as required by s. 506C
  132  of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
  133         2. Reclassify a drug to a more restrictive drug tier or
  134  increase the amount that an insured must pay for a copayment,
  135  coinsurance, or deductible for prescription drug benefits, or
  136  reclassify a drug to a higher cost-sharing tier during the
  137  contract year.
  138         (b) This subsection does not:
  139         1. Prohibit the addition of prescription drugs to the list
  140  of drugs covered during the contract year.
  141         2. Apply to a grandfathered health plan as defined in s.
  142  627.402 or to benefits set forth in s. 627.6513(1)-(14).
  143         3. Alter or amend s. 465.025, which provides conditions
  144  under which a pharmacist may substitute a generically equivalent
  145  drug product for a brand name drug product.
  146         4. Alter or amend s. 465.0252, which provides conditions
  147  under which a pharmacist may dispense a substitute biological
  148  product for the prescribed biological product.
  149         Section 5. The Legislature finds that the creation of s.
  150  627.42393, Florida Statutes, and the amendments to ss. 627.6699
  151  and 641.31, Florida Statutes, made by this act fulfill an
  152  important state interest.
  153         Section 6. Except as otherwise expressly provided in this
  154  act, this act shall take effect July 1, 2017.
  155  
  156  ================= T I T L E  A M E N D M E N T ================
  157  And the title is amended as follows:
  158         Delete lines 2 - 13
  159  and insert:
  160         An act relating to health care; creating s. 624.27,
  161         F.S.; providing definitions; specifying that a direct
  162         primary care agreement does not constitute insurance
  163         and is not subject to the Florida Insurance Code;
  164         specifying that entering into a direct primary care
  165         agreement does not constitute the business of
  166         insurance and is not subject to the code; providing
  167         that a certificate of authority is not required to
  168         market, sell, or offer to sell a direct primary care
  169         agreement; specifying requirements for a direct
  170         primary care agreement; creating s. 627.42393, F.S.;
  171         limiting, under specified circumstances, changes to a
  172         health insurance policy prescription drug formulary
  173         during a policy year; providing construction and
  174         applicability; amending s. 627.6699, F.S.; requiring
  175         small employer carriers to limit changes to
  176         prescription drug formularies under certain
  177         circumstances; amending s. 641.31, F.S.; limiting,
  178         under specified circumstances, changes to a health
  179         maintenance contract prescription drug formulary
  180         during a contract year; providing construction and
  181         applicability; providing a declaration of important
  182         state interest; providing effective dates.