Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. SB 7078
       
       
       
       
       
       
                                Ì870336*Î870336                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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       Appropriations Subcommittee on Health and Human Services
       (Harrell) recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete lines 583 - 609
    4  and insert:
    5         (3) This section does not require a health insurer to add a
    6  drug to its prescription drug formulary or to cover a
    7  prescription drug that the insurer does not otherwise cover.
    8         Section 11. Effective January 1, 2020, subsection (45) is
    9  added to section 641.31, Florida Statutes, to read:
   10         641.31 Health maintenance contracts.—
   11         (45)(a) A health maintenance organization issuing major
   12  medical coverage through an individual or group contract may not
   13  require a step-therapy protocol under the contract for a covered
   14  prescription drug requested by a subscriber if:
   15         1. The subscriber has previously been approved to receive
   16  the prescription drug through the completion of a step-therapy
   17  protocol required by a separate health coverage plan; and
   18         2. The subscriber provides documentation originating from
   19  the health coverage plan that approved the prescription drug as
   20  described in subparagraph 1. indicating that the health coverage
   21  plan paid for the drug on the subscriber’s behalf during the 180
   22  days immediately prior to the request.
   23         (b) As used in this subsection, the term “health coverage
   24  plan” means any of the following which previously provided or is
   25  currently providing major medical or similar comprehensive
   26  coverage or benefits to the subscriber:
   27         1. A health insurer or health maintenance organization;
   28         2. A plan established or maintained by an individual
   29  employer as provided by the Employee Retirement Income Security
   30  Act of 1974, Pub. L. No. 93-406;
   31         3. A multiple-employer welfare arrangement as defined in s.
   32  624.437; or
   33         4. A governmental entity providing a plan of self
   34  insurance.
   35         (c) This subsection does not require a health maintenance
   36  organization to add a drug to its prescription drug formulary or
   37  to cover a prescription drug that the health maintenance
   38  organization does not otherwise cover.
   39  
   40  ================= T I T L E  A M E N D M E N T ================
   41  And the title is amended as follows:
   42         Delete lines 80 - 84
   43  and insert:
   44         term “health coverage plan”; clarifying that a health
   45         insurer is not required to take specific actions
   46         regarding prescription drugs; amending s. 641.31,
   47         F.S.; prohibiting certain health maintenance
   48         organizations from employing step-therapy protocols
   49         under certain circumstances; defining the term “health
   50         coverage plan”; clarifying that a health maintenance
   51         organization is not required to take specific actions
   52         regarding prescription drugs; amending s. 409.973,
   53         F.S.; prohibiting Medicaid