Florida Senate - 2018               CS for CS for CS for SB 1494
       
       
        
       By the Committees on Appropriations; Banking and Insurance; and
       Health Policy; and Senators Montford, Grimsley, and Powell
       
       
       
       
       576-04148-18                                          20181494c3
    1                        A bill to be entitled                      
    2         An act relating to prescription drug pricing
    3         transparency; amending s. 465.0244, F.S.; requiring
    4         pharmacists to inform customers of less expensive,
    5         generically equivalent drugs for their prescriptions
    6         and as to whether customers’ cost-sharing obligations
    7         exceed the retail price of their prescriptions;
    8         repealing s. 465.1862, F.S., relating to pharmacy
    9         benefit manager contracts; creating s. 624.490, F.S.;
   10         defining the term “pharmacy benefit manager”;
   11         requiring a pharmacy benefit manager to register with
   12         the Office of Insurance Regulation beginning on a
   13         specified date; providing requirements and terms of
   14         registration, including the payment of a nonrefundable
   15         fee; requiring the office to issue certificates of
   16         registration; specifying that certificates are
   17         nontransferable; requiring the Financial Services
   18         Commission to set an initial registration fee and a
   19         renewal fee which are nonrefundable and may not exceed
   20         a specified amount; requiring the commission to adopt
   21         rules; creating ss. 627.64741, 627.6572, and 641.314,
   22         F.S.; defining the terms “maximum allowable cost” and
   23         “pharmacy benefit manager”; requiring that certain
   24         terms be included in a contract between a health
   25         insurer or a health maintenance organization and a
   26         pharmacy benefit manager; providing applicability;
   27         providing an appropriation; providing an effective
   28         date.
   29          
   30  Be It Enacted by the Legislature of the State of Florida:
   31  
   32         Section 1. Section 465.0244, Florida Statutes, is amended
   33  to read:
   34         465.0244 Information disclosure.—
   35         (1) Every pharmacy shall make available on its website a
   36  hyperlink to the health information that is disseminated by the
   37  Agency for Health Care Administration pursuant to s. 408.05(3)
   38  and shall place in the area where customers receive filled
   39  prescriptions notice that such information is available
   40  electronically and the address of its Internet website.
   41         (2)In addition to the requirements of s. 465.025, a
   42  pharmacist or her or his authorized employee must inform a
   43  customer of a less expensive, generically equivalent drug
   44  product for her or his prescription and as to whether the
   45  customer’s cost-sharing obligation exceeds the retail price of
   46  the prescription in the absence of prescription drug coverage.
   47         Section 2. Section 465.1862, Florida Statutes, is repealed.
   48         Section 3. Section 624.490, Florida Statutes, is created to
   49  read:
   50         624.490Registration of pharmacy benefit managers.—
   51         (1)As used in this section, the term “pharmacy benefit
   52  manager” means a person or entity doing business in this state
   53  which contracts to administer prescription drug benefits on
   54  behalf of a health insurer or a health maintenance organization
   55  to residents of this state.
   56         (2) Beginning January 1, 2019, a pharmacy benefit manager
   57  must register with the office to conduct business in this state.
   58  To initially register or renew a registration, a pharmacy
   59  benefit manager must submit:
   60         (a)A nonrefundable fee;
   61         (b)A copy of the registrant’s corporate charter, articles
   62  of incorporation, or other charter document; and
   63         (c)A completed registration on a form adopted by the
   64  commission which contains:
   65         1.The name and address of the registrant; and
   66         2.The name, address, and official position of each officer
   67  and director of the registrant.
   68         (3)The registrant shall report any change in information
   69  required by subsection (2) to the office in writing within 60
   70  days after the change occurs.
   71         (4)Upon receipt of a completed registration form, required
   72  documents, and the registration fee, the office shall issue a
   73  registration certificate. The certificate may be in paper or
   74  electronic form, and must indicate the expiration date of the
   75  registration. Registration certificates are nontransferable.
   76         (5)A registration certificate is valid for 2 years from
   77  its date of issue. The commission shall adopt by rule an initial
   78  registration fee not to exceed $500 and a registration renewal
   79  fee not to exceed $500, both of which are nonrefundable.
   80         (6)The commission shall adopt rules necessary to implement
   81  this section.
   82         Section 4. Section 627.64741, Florida Statutes, is created
   83  to read:
   84         627.64741Pharmacy benefit manager contracts.—
   85         (1)As used in this section, the term:
   86         (a)“Maximum allowable cost” means the per-unit amount that
   87  a pharmacy benefit manager reimburses a pharmacist for a
   88  prescription drug, excluding dispensing fees, prior to the
   89  application of copayments, coinsurance, and other cost-sharing
   90  charges, if any.
   91         (b)“Pharmacy benefit manager” means a person or entity
   92  doing business in this state which contracts to administer or
   93  manage prescription drug benefits on behalf of a health insurer
   94  to residents of this state.
   95         (2)A contract between a health insurer and a pharmacy
   96  benefit manager must require that the pharmacy benefit manager:
   97         (a)Update maximum allowable cost pricing information at
   98  least every 7 calendar days.
   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 cost prices and product
  103  availability.
  104         (3)A contract between a health insurer and a pharmacy
  105  benefit manager must prohibit the pharmacy benefit manager from
  106  limiting a pharmacist’s ability to disclose whether the cost
  107  sharing obligation exceeds the retail price for a covered
  108  prescription drug, and the availability of a more affordable
  109  alternative drug, pursuant to s. 465.0244.
  110         (4)A contract between a health insurer and a pharmacy
  111  benefit manager must prohibit the pharmacy benefit manager from
  112  requiring an insured to make a payment for a prescription drug
  113  at the point of sale in an amount that exceeds the lesser of:
  114         (a)The applicable cost-sharing amount; or
  115         (b)The retail price of the drug in the absence of
  116  prescription drug coverage.
  117         (5) This section applies to contracts entered into or
  118  renewed on or after July 1, 2018.
  119         Section 5. Section 627.6572, Florida Statutes, is created
  120  to read:
  121         627.6572Pharmacy benefit manager contracts.—
  122         (1)As used in this section, the term:
  123         (a)“Maximum allowable cost” means the per-unit amount that
  124  a pharmacy benefit manager reimburses a pharmacist for a
  125  prescription drug, excluding dispensing fees, prior to the
  126  application of copayments, coinsurance, and any other cost
  127  sharing charges.
  128         (b)“Pharmacy benefit manager” means a person or entity
  129  doing business in this state which contracts to administer or
  130  manage prescription drug benefits on behalf of a health insurer
  131  to residents of this state.
  132         (2)A contract between a health insurer and a pharmacy
  133  benefit manager must require that the pharmacy benefit manager:
  134         (a)Update maximum allowable cost pricing information at
  135  least every 7 calendar days.
  136         (b)Maintain a process that will, in a timely manner,
  137  eliminate drugs from maximum allowable cost lists or modify drug
  138  prices to remain consistent with changes in pricing data used in
  139  formulating maximum allowable cost prices and product
  140  availability.
  141         (3)A contract between a health insurer and a pharmacy
  142  benefit manager must prohibit the pharmacy benefit manager from
  143  limiting a pharmacist’s ability to disclose whether the cost
  144  sharing obligation exceeds the retail price for a covered
  145  prescription drug, and the availability of a more affordable
  146  alternative drug, pursuant to s. 465.0244.
  147         (4)A contract between a health insurer and a pharmacy
  148  benefit manager must prohibit the pharmacy benefit manager from
  149  requiring an insured to make a payment for a prescription drug
  150  at the point of sale in an amount that exceeds the lesser of:
  151         (a)The applicable cost-sharing amount; or
  152         (b)The retail price of the drug in the absence of
  153  prescription drug coverage.
  154         (5) This section applies to contracts entered into or
  155  renewed on or after July 1, 2018.
  156         Section 6. Section 641.314, Florida Statutes, is created to
  157  read:
  158         641.314Pharmacy benefit manager contracts.—
  159         (1)As used in this section, the term:
  160         (a)“Maximum allowable cost” means the per-unit amount that
  161  a pharmacy benefit manager reimburses a pharmacist for a
  162  prescription drug, excluding dispensing fees, prior to the
  163  application of copayments, coinsurance, and any other cost
  164  sharing charges.
  165         (b)“Pharmacy benefit manager” means a person or entity
  166  doing business in this state which contracts to administer or
  167  manage prescription drug benefits on behalf of a health
  168  maintenance organization to residents of this state.
  169         (2)A contract between a health maintenance organization
  170  and a pharmacy benefit manager must require that the pharmacy
  171  benefit manager:
  172         (a)Update maximum allowable cost pricing information at
  173  least every 7 calendar days.
  174         (b)Maintain a process that will, in a timely manner,
  175  eliminate drugs from maximum allowable cost lists or modify drug
  176  prices to remain consistent with changes in pricing data used in
  177  formulating maximum allowable cost prices and product
  178  availability.
  179         (3)A contract between a health maintenance organization
  180  and a pharmacy benefit manager must prohibit the pharmacy
  181  benefit manager from limiting a pharmacist’s ability to disclose
  182  whether the cost-sharing obligation exceeds the retail price for
  183  a covered prescription drug, and the availability of a more
  184  affordable alternative drug, pursuant to s. 465.0244.
  185         (4)A contract between a health maintenance organization
  186  and a pharmacy benefit manager must prohibit the pharmacy
  187  benefit manager from requiring a subscriber to make a payment
  188  for a prescription drug at the point of sale in an amount that
  189  exceeds the lesser of:
  190         (a)The applicable cost-sharing amount; or
  191         (b)The retail price of the drug in the absence of
  192  prescription drug coverage.
  193         (5) This section applies to contracts entered into or
  194  renewed on or after July 1, 2018.
  195         Section 7. The sums of $74,141 in recurring funds and
  196  $5,000 in nonrecurring funds from the Insurance Regulatory Trust
  197  Fund are appropriated to the Office of Insurance Regulation, and
  198  one full-time equivalent position with associated salary rate of
  199  45,043 is authorized, for the purpose of implementing this act.
  200         Section 8. This act shall take effect July 1, 2018.