Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. SB 1180
       
       
       
       
       
       
                                Ì675178OÎ675178                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: WD            .                                
                  03/18/2019           .                                
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       The Committee on Banking and Insurance (Gruters) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 627.42393, Florida Statutes, is created
    6  to read:
    7         627.42393Individual health insurance policies; limiting
    8  changes to prescription drug formularies.—
    9         (1)Other than at the time of coverage renewal, an
   10  individual insurance policy that is delivered, issued for
   11  delivery, renewed, amended, or continued in this state and that
   12  provides medical, major medical, or similar comprehensive
   13  coverage may not, while the insured is taking a prescription
   14  drug:
   15         (a)Remove the prescription drug from its list of covered
   16  drugs during the policy year unless the United States Food and
   17  Drug Administration has issued a statement about the drug which
   18  calls into question the clinical safety of the drug or the
   19  manufacturer of the drug has notified the United States Food and
   20  Drug Administration of a manufacturing discontinuance or
   21  potential discontinuance of the drug as required by s. 506C of
   22  the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
   23         (b)Reclassify the drug to a more restrictive drug tier or
   24  increase the amount that an insured must pay for a copayment,
   25  coinsurance, or deductible for prescription drug benefits or
   26  reclassify the drug to a higher cost-sharing tier during the
   27  policy year.
   28         (2)This section does not:
   29         (a) Prohibit the addition of prescription drugs to the list
   30  of drugs covered under the policy during the policy year.
   31         (b)Apply to a grandfathered health plan as defined in s.
   32  627.402, to benefits set forth in s. 627.6513(1)-(14), or to any
   33  individual policy issued or delivered between March 23, 2010,
   34  and December 31, 2013, inclusive.
   35         (c)Alter or amend s. 465.025, which provides conditions
   36  under which a pharmacist may substitute a generically equivalent
   37  drug product for a brand name drug product.
   38         (d)Alter or amend s. 465.0252, which provides conditions
   39  under which a pharmacist may dispense a substitute biological
   40  product for the prescribed biological product.
   41         (e) Apply to a Medicaid managed care plan under part IV of
   42  chapter 409.
   43         (f)Apply if the drug manufacturer increases the list price
   44  of the prescription drug on the health insurer’s formulary to
   45  the health insurer or the pharmacy benefit manager after
   46  November 1 of the year before the health insurer’s earliest
   47  required rate submission date to applicable state and federal
   48  rate review authorities for the succeeding calendar or policy
   49  year. Any changes in the health insurer’s formulary must be
   50  documented for internal purposes.
   51         Section 2. Subsection (36) of section 641.31, Florida
   52  Statutes, is amended to read:
   53         641.31 Health maintenance contracts.—
   54         (36) A health maintenance organization may increase the
   55  copayment for any benefit, or delete, amend, or limit any of the
   56  benefits to which a subscriber is entitled under the group
   57  contract only, upon written notice to the contract holder at
   58  least 45 days in advance of the time of coverage renewal. The
   59  health maintenance organization may amend the contract with the
   60  contract holder, with such amendment to be effective immediately
   61  at the time of coverage renewal. The written notice to the
   62  contract holder must shall specifically identify any deletions,
   63  amendments, or limitations to any of the benefits provided in
   64  the group contract during the current contract period which will
   65  be included in the group contract upon renewal. This subsection
   66  does not apply to any increases in benefits. The 45-day notice
   67  requirement does shall not apply if benefits are amended,
   68  deleted, or limited at the request of the contract holder.
   69         (a) With respect to individual health maintenance contracts
   70  only, other than at the time of coverage renewal, a health
   71  maintenance contract that provides medical, major medical, or
   72  similar comprehensive coverage may not, while the subscriber is
   73  taking a prescription drug:
   74         1. Remove the prescription drug from its list of covered
   75  drugs during the contract year unless the United States Food and
   76  Drug Administration has issued a statement about the drug which
   77  calls into question the clinical safety of the drug or the
   78  manufacturer of the drug has notified the United States Food and
   79  Drug Administration of a manufacturing discontinuance or
   80  potential discontinuance of the drug as required by s. 506C of
   81  the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
   82         2. Reclassify the drug to a more restrictive drug tier or
   83  increase the amount that an insured must pay for a copayment,
   84  coinsurance, or deductible for prescription drug benefits or
   85  reclassify the drug to a higher cost-sharing tier during the
   86  contract year.
   87         (b) This subsection does not:
   88         1. Prohibit the addition of prescription drugs to the list
   89  of drugs covered during the contract year.
   90         2. Apply to a grandfathered health plan as defined in s.
   91  627.402 or to benefits set forth in s. 627.6513(1)-(14).
   92         3. Alter or amend s. 465.025, which provides conditions
   93  under which a pharmacist may substitute a generically equivalent
   94  drug product for a brand name drug product.
   95         4. Alter or amend s. 465.0252, which provides conditions
   96  under which a pharmacist may dispense a substitute biological
   97  product for the prescribed biological product.
   98         5. Apply to a Medicaid managed care plan under part IV of
   99  chapter 409.
  100         6.Apply if the drug manufacturer increases the list price
  101  of the prescription drug on the health maintenance
  102  organization’s formulary to the health maintenance organization
  103  or the pharmacy benefit manager after November 1 of the year
  104  before the health maintenance organization’s earliest required
  105  rate submission date to applicable state and federal rate review
  106  authorities for the succeeding calendar or policy year. Any
  107  changes in the health maintenance organization’s formulary must
  108  be documented for internal purposes.
  109         7.Apply to group health maintenance organization
  110  contracts.
  111         Section 3. This act shall take effect January 1, 2020.
  112  
  113  ================= T I T L E  A M E N D M E N T ================
  114  And the title is amended as follows:
  115         Delete everything before the enacting clause
  116  and insert:
  117                        A bill to be entitled                      
  118         An act relating to consumer protection from nonmedical
  119         changes to prescription drug formularies; creating s.
  120         627.42393, F.S.; prohibiting specified changes to
  121         certain individual health insurance policy
  122         prescription drug formularies, except under certain
  123         circumstances; providing construction and
  124         applicability; providing that such prohibition does
  125         not apply for certain prescription drug price
  126         increases; requiring that formulary changes be
  127         documented for internal purposes; amending s. 641.31,
  128         F.S.; prohibiting certain health maintenance
  129         organizations from making specified changes to
  130         individual health maintenance contract prescription
  131         drug formularies, except under certain circumstances;
  132         providing construction and applicability; providing
  133         that such prohibition does not apply for certain
  134         prescription drug price increases; requiring that
  135         formulary changes be documented for internal purposes;
  136         providing an effective date.