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The Florida Senate

2018 Florida Statutes

Title X PUBLIC OFFICERS, EMPLOYEES, AND RECORDS
Chapter 110 STATE EMPLOYMENT Entire Chapter
SECTION 12315
Prescription drug program.
F.S. 110.12315
1110.12315 Prescription drug program.—The state employees’ prescription drug program is established. This program shall be administered by the Department of Management Services, according to the terms and conditions of the plan as established by the relevant provisions of the annual General Appropriations Act and implementing legislation, subject to the following conditions:
(1) The department shall allow prescriptions written by health care providers under the plan to be filled by any licensed pharmacy and reimbursed pursuant to subsection (2). This section may not be construed as prohibiting a mail order prescription drug program distinct from the service provided by retail pharmacies.
(2) In providing for reimbursement of pharmacies for prescription drugs and supplies dispensed to members of the state group health insurance plan and their dependents under the state employees’ prescription drug program:
(a) Retail, mail order, and specialty pharmacies participating in the program must be reimbursed as established by contract and according to the terms and conditions of the plan.
(b) There is a 30-day supply limit for retail pharmacy fills, a 90-day supply limit for mail order fills, and a 90-day supply limit for maintenance drug fills by retail pharmacies. This paragraph may not be construed to prohibit fills at any amount less than the applicable supply limit.
(c) The pharmacy dispensing fee shall be negotiated by the department.
(d) The department shall establish the reimbursement schedule for prescription drugs and supplies dispensed under the program. Reimbursement rates for a prescription drug or supply must be based on the cost of the generic equivalent drug or supply if a generic equivalent exists, unless the physician, advanced practice registered nurse, or physician assistant prescribing the drug or supply clearly states on the prescription that the brand name drug or supply is medically necessary or that the drug or supply is included on the formulary of drugs and supplies that may not be interchanged as provided in chapter 465, in which case reimbursement must be based on the cost of the brand name drug or supply as specified in the reimbursement schedule adopted by the department.
(3) The department shall maintain the generic, preferred brand name, and the nonpreferred brand name lists of drugs and supplies to be used in the administration of the state employees’ prescription drug program.
(4) The department shall maintain a list of maintenance drugs and supplies.
(a) Preferred provider organization health plan members may have prescriptions for maintenance drugs and supplies filled up to three times as a supply for up to 30 days through a retail pharmacy; thereafter, prescriptions for the same maintenance drug or supply must be filled for up to 90 days either through the department’s contracted mail order pharmacy or through a retail pharmacy.
(b) Health maintenance organization health plan members may have prescriptions for maintenance drugs and supplies filled for up to 90 days either through a mail order pharmacy or through a retail pharmacy.
(5) Copayments made by health plan members for a supply for up to 90 days through a retail pharmacy shall be the same as copayments made for a similar supply through the department’s contracted mail order pharmacy.
(6) The department shall conduct a prescription utilization review program. In order to participate in the state employees’ prescription drug program, retail pharmacies dispensing prescription drugs and supplies to members of the state group health insurance plan or their covered dependents, or to subscribers or covered dependents of a health maintenance organization plan under the state group insurance program, shall make their records available for this review.
(7) Participating pharmacies must use a point-of-sale device or an online computer system to verify a participant’s eligibility for coverage. The state is not liable for reimbursement of a participating pharmacy for dispensing prescription drugs and supplies to any person whose current eligibility for coverage has not been verified by the state’s contracted administrator or by the department.
(8)(a) Effective July 1, 2017, for the State Group Health Insurance Standard Plan, copayments must be made as follows:
1. For a supply for up to 30 days from a retail pharmacy:
a. For generic drug..........$7.
b. For preferred brand name drug..........$30.
c. For nonpreferred brand name drug..........$50.
2. For a supply for up to 90 days from a mail order pharmacy or a retail pharmacy:
a. For generic drug..........$14.
b. For preferred brand name drug..........$60.
c. For nonpreferred brand name drug..........$100.
(b) Effective July 1, 2017, for the State Group Health Insurance High Deductible Plan, coinsurance must be paid as follows:
1. For a supply for up to 30 days from a retail pharmacy:
a. For generic drug..........30%.
b. For preferred brand name drug..........30%.
c. For nonpreferred brand name drug..........50%.
2. For a supply for up to 90 days from a mail order pharmacy or a retail pharmacy:
a. For generic drug..........30%.
b. For preferred brand name drug..........30%.
c. For nonpreferred brand name drug..........50%.
History.—s. 53, ch. 92-69; s. 32, ch. 96-399; s. 4, ch. 97-92; ss. 37, 53, ch. 99-228; s. 7, ch. 99-255; s. 62, ch. 2000-171; s. 46, ch. 2001-254; s. 44, ch. 2002-402; s. 39, ch. 2003-399; ss. 33, 76, ch. 2004-269; s. 1, ch. 2004-347; s. 4, ch. 2005-97; s. 4, ch. 2006-18; s. 71, ch. 2010-153; ss. 74, 75, ch. 2011-47; ss. 52, 53, ch. 2012-119; ss. 53, 54, ch. 2013-41; ss. 63, 64, ch. 2014-53; ss. 85, 86, ch. 2015-222; ss. 122, 123, ch. 2016-62; s. 1, ch. 2016-224; s. 2, ch. 2017-127; s. 8, ch. 2018-106.
1Note.—Section 8, ch. 99-255, provides that “[t]he Department of Management Services shall not implement a prior authorization program or a restricted formulary program that restricts a non-HMO enrollee’s access to prescription drugs beyond the provisions of [paragraph (2)(d)] related specifically to generic equivalents for prescriptions and the provisions in [subsection (9)] related specifically to starter dose programs or the dispensing of long-term maintenance medications. The prior authorization program expanded pursuant to section 8 of the 1998-1999 General Appropriations Act is hereby terminated. If this section conflicts with any General Appropriations Act or any act implementing a General Appropriations Act, the Legislature intends that the provisions of this section shall prevail. This section shall take effect upon becoming law.” Former subsection (9) of s. 110.12315, Florida Statutes 2016, was repealed by s. 2, ch. 2017-127.