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
shallspecifically 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 shallnot 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.