Florida Senate - 2020                        COMMITTEE AMENDMENT
       Bill No. CS for SB 1338
       
       
       
       
       
       
                                Ì636790<Î636790                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  02/25/2020           .                                
                                       .                                
                                       .                                
                                       .                                
       —————————————————————————————————————————————————————————————————




       —————————————————————————————————————————————————————————————————
       Appropriations Subcommittee on Health and Human Services
       (Wright) recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete lines 210 - 508
    4  and insert:
    5         (a) “Maximum allowable cost” means the per-unit amount that
    6  a pharmacy benefit manager reimburses a pharmacist for a
    7  prescription drug, excluding dispensing fees, prior to the
    8  application of copayments, coinsurance, and other cost-sharing
    9  charges, if any.
   10         (b) “Pharmacy benefit manager” means a person or entity
   11  doing business in this state which contracts to administer or
   12  manage prescription drug benefits on behalf of a health insurer
   13  to residents of this state.
   14         (2) A health insurer may contract only with a pharmacy
   15  benefit manager that A contract between a health insurer and a
   16  pharmacy benefit manager must require that the pharmacy benefit
   17  manager:
   18         (a) Updates Update maximum allowable cost pricing
   19  information at least every 7 calendar days.
   20         (b) Maintains Maintain a process that will, in a timely
   21  manner, eliminate drugs from maximum allowable cost lists or
   22  modify drug prices to remain consistent with changes in pricing
   23  data used in formulating maximum allowable cost prices and
   24  product availability.
   25         (c)(3)Does not limit A contract between a health insurer
   26  and a pharmacy benefit manager must prohibit the pharmacy
   27  benefit manager from limiting a pharmacist’s ability to disclose
   28  whether the cost-sharing obligation exceeds the retail price for
   29  a covered prescription drug, and the availability of a more
   30  affordable alternative drug, pursuant to s. 465.0244.
   31         (d)(4)Does not require A contract between a health insurer
   32  and a pharmacy benefit manager must prohibit the pharmacy
   33  benefit manager from requiring an insured to make a payment for
   34  a prescription drug at the point of sale in an amount that
   35  exceeds the lesser of:
   36         1.(a) The applicable cost-sharing amount; or
   37         2.(b) The retail price of the drug in the absence of
   38  prescription drug coverage.
   39         (3)The office may require a health insurer to submit to
   40  the office any contract, or amendments to a contract, for the
   41  administration or management of prescription drug benefits by a
   42  pharmacy benefit manager on behalf of the insurer.
   43         (4)After review of a contract under subsection (3), the
   44  office may order the insurer to cancel the contract in
   45  accordance with the terms of the contract and applicable law if
   46  the office determines that any of the following conditions
   47  exist:
   48         (a)The fees to be paid by the insurer are so unreasonably
   49  high as compared with similar contracts entered into by
   50  insurers, or as compared with similar contracts entered into by
   51  other insurers in similar circumstances, that the contract is
   52  detrimental to the policyholders of the insurer.
   53         (b)The contract does not comply with the Florida Insurance
   54  Code.
   55         (c)The pharmacy benefit manager is not registered with the
   56  office pursuant to s. 624.490.
   57         (5)The commission may adopt rules to administer this
   58  section.
   59         (6)(5) This section applies to contracts entered into,
   60  amended, or renewed on or after July 1, 2020 2018.
   61         Section 5. Section 627.6572, Florida Statutes, is amended
   62  to read:
   63         627.6572 Pharmacy benefit manager contracts.—
   64         (1) As used in this section, the term:
   65         (a) “Maximum allowable cost” means the per-unit amount that
   66  a pharmacy benefit manager reimburses a pharmacist for a
   67  prescription drug, excluding dispensing fees, prior to the
   68  application of copayments, coinsurance, and other cost-sharing
   69  charges, if any.
   70         (b) “Pharmacy benefit manager” means a person or entity
   71  doing business in this state which contracts to administer or
   72  manage prescription drug benefits on behalf of a health insurer
   73  to residents of this state.
   74         (2) A health insurer may contract only with a pharmacy
   75  benefit manager that A contract between a health insurer and a
   76  pharmacy benefit manager must require that the pharmacy benefit
   77  manager:
   78         (a) Updates Update maximum allowable cost pricing
   79  information at least every 7 calendar days.
   80         (b) Maintains Maintain a process that will, in a timely
   81  manner, eliminate drugs from maximum allowable cost lists or
   82  modify drug prices to remain consistent with changes in pricing
   83  data used in formulating maximum allowable cost prices and
   84  product availability.
   85         (c)(3)Does not limit A contract between a health insurer
   86  and a pharmacy benefit manager must prohibit the pharmacy
   87  benefit manager from limiting a pharmacist’s ability to disclose
   88  whether the cost-sharing obligation exceeds the retail price for
   89  a covered prescription drug, and the availability of a more
   90  affordable alternative drug, pursuant to s. 465.0244.
   91         (d)(4)Does not require A contract between a health insurer
   92  and a pharmacy benefit manager must prohibit the pharmacy
   93  benefit manager from requiring an insured to make a payment for
   94  a prescription drug at the point of sale in an amount that
   95  exceeds the lesser of:
   96         1.(a) The applicable cost-sharing amount; or
   97         2.(b) The retail price of the drug in the absence of
   98  prescription drug coverage.
   99         (3)The office may require a health insurer to submit to
  100  the office any contract, or amendments to a contract, for the
  101  administration or management of prescription drug benefits by a
  102  pharmacy benefit manager on behalf of the insurer.
  103         (4)After review of a contract under subsection (3), the
  104  office may order the insurer to cancel the contract in
  105  accordance with the terms of the contract and applicable law if
  106  the office determines that any of the following conditions
  107  exist:
  108         (a)The fees to be paid by the insurer are so unreasonably
  109  high as compared with similar contracts entered into by
  110  insurers, or as compared with similar contracts entered into by
  111  other insurers in similar circumstances, that the contract is
  112  detrimental to the policyholders of the insurer.
  113         (b)The contract does not comply with the Florida Insurance
  114  Code.
  115         (c)The pharmacy benefit manager is not registered with the
  116  office pursuant to s. 624.490.
  117         (5)The commission may adopt rules to administer this
  118  section.
  119         (6)(5) This section applies to contracts entered into,
  120  amended, or renewed on or after July 1, 2020 2018.
  121         Section 6. Section 641.314, Florida Statutes, is amended to
  122  read:
  123         641.314 Pharmacy benefit manager contracts.—
  124         (1) As used in this section, the term:
  125         (a) “Maximum allowable cost” means the per-unit amount that
  126  a pharmacy benefit manager reimburses a pharmacist for a
  127  prescription drug, excluding dispensing fees, prior to the
  128  application of copayments, coinsurance, and other cost-sharing
  129  charges, if any.
  130         (b) “Pharmacy benefit manager” means a person or entity
  131  doing business in this state which contracts to administer or
  132  manage prescription drug benefits on behalf of a health
  133  maintenance organization to residents of this state.
  134         (2) A health maintenance organization may contract only
  135  with a pharmacy benefit manager that A contract between a health
  136  maintenance organization and a pharmacy benefit manager must
  137  require that the pharmacy benefit manager:
  138         (a) Updates Update maximum allowable cost pricing
  139  information at least every 7 calendar days.
  140         (b) Maintains Maintain a process that will, in a timely
  141  manner, eliminate drugs from maximum allowable cost lists or
  142  modify drug prices to remain consistent with changes in pricing
  143  data used in formulating maximum allowable cost prices and
  144  product availability.
  145         (c)(3)Does not limit A contract between a health
  146  maintenance organization and a pharmacy benefit manager must
  147  prohibit the pharmacy benefit manager from limiting a
  148  pharmacist’s ability to disclose whether the cost-sharing
  149  obligation exceeds the retail price for a covered prescription
  150  drug, and the availability of a more affordable alternative
  151  drug, pursuant to s. 465.0244.
  152         (d)(4)Does not require A contract between a health
  153  maintenance organization and a pharmacy benefit manager must
  154  prohibit the pharmacy benefit manager from requiring a
  155  subscriber to make a payment for a prescription drug at the
  156  point of sale in an amount that exceeds the lesser of:
  157         1.(a) The applicable cost-sharing amount; or
  158         2.(b) The retail price of the drug in the absence of
  159  prescription drug coverage.
  160         (3)The office may require a health maintenance
  161  organization to submit to the office any contract, or amendments
  162  to a contract, for the administration or management of
  163  prescription drug benefits by a pharmacy benefit manager on
  164  behalf of the health maintenance organization.
  165         (4)After review of a contract under subsection (3), the
  166  office may order the health maintenance organization to cancel
  167  the contract in accordance with the terms of the contract and
  168  applicable law if the office determines that any of the
  169  following conditions exist:
  170         (a)The fees to be paid by the health maintenance
  171  organization are so unreasonably high as compared with similar
  172  contracts entered into by health maintenance organizations, or
  173  as compared with similar contracts entered into by other health
  174  maintenance organizations in similar circumstances, that the
  175  contract is detrimental to the subscribers of the health
  176  maintenance organization.
  177         (b)The contract does not comply with the Florida Insurance
  178  Code.
  179         (c)The pharmacy benefit manager is not registered with the
  180  office pursuant to s. 624.490.
  181         (5)The commission may adopt rules to administer this
  182  section.
  183         (6)(5) This section applies to pharmacy benefit manager
  184  
  185  ================= T I T L E  A M E N D M E N T ================
  186  And the title is amended as follows:
  187         Delete lines 25 - 35
  188  and insert:
  189         F.S.; authorizing the office to require health
  190         insurers or health maintenance organizations to submit
  191         to the office certain contracts or contract amendments
  192         entered into with pharmacy benefit managers;