HB 1599 2003
1	A bill to be entitled
2	An act relating to pharmacy benefit managers; creating s.
3	465.189, F.S.; establishing standards and criteria for
4	regulation and licensing of pharmacy benefit managers;
5	providing a popular name; providing purpose, intent, and
6	applicability; providing definitions; requiring a biennial
7	certificate of authority and an annual license; providing
8	rulemaking authority to the Board of Pharmacy and the
9	Office of Insurance Regulation; requiring an annual
10	statement; providing for financial examinations; providing
11	for assessments and fees; providing for pharmacy benefit
12	manager contracts; providing for enforcement; providing
13	for medication reimbursement costs; specifying prohibited
14	practices; preserving existing contracts and providing
15	prospective application for new contracts; providing for
16	control over conflicting provisions of law; providing an
17	effective date.
18
19	Be It Enacted by the Legislature of the State of Florida:
20
21	Section 1. Section 465.189, Florida Statutes, is created
22	to read:
23	465.189 Pharmacy benefit managers.--
24	(1) POPULAR NAME.--This section shall be known by the
25	popular name the "Florida Pharmacy Benefit Management Regulation
26	Act."
27	(2) PURPOSE AND INTENT; APPLICABILITY.--
28	(a)1. This section establishes standards and criteria for
29	the regulation and licensing of pharmacy benefit managers.
30	2. The purpose of this section is to:
31	a. Promote, preserve, and protect the public health,
32	safety, and welfare through effective regulation and licensing
33	of pharmacy benefit managers.
34	b. Provide for certain powers and duties for certain state
35	agencies and officers.
36	c. Prescribe penalties for violations of this section.
37	(b) A pharmacy benefit manager is subject to this section
38	if the pharmacy benefit manager provides claims-processing
39	services, other prescription drug or device services, or both,
40	to patients who are residents of this state.
41	(c) A pharmacy benefit manager may not do business or
42	provide services in this state unless the pharmacy benefit
43	manager is in full compliance with this section.
44	(3) DEFINITIONS.--For purposes of this section:
45	(a) "Board" means the Board of Pharmacy.
46	(b) "Cease and desist order" means an order of the board
47	or office prohibiting a pharmacy benefit manager or other person
48	or entity from continuing a particular course of conduct that
49	violates this section or rules adopted under this section.
50	(c) "Claims-processing services" means the administrative
51	services performed in connection with the processing and
52	adjudication of claims relating to pharmacist's services,
53	including, but not limited to, making payments to pharmacists
54	and pharmacies.
55	(d) "Maintenance drug" means a drug prescribed by a
56	practitioner who is licensed to prescribe drugs and used to
57	treat a medical condition for a period greater than 30 days.
58	(e) "Multi-source drug" means a drug that is stocked and
59	available from three or more suppliers.
60	(f) "Office" means the Office of Insurance Regulation of
61	the Financial Services Commission.
62	(g) "Other prescription drug or device services" means
63	services other than claims-processing services, provided
64	directly or indirectly by a pharmacy benefit manager, whether in
65	connection with or separate from claims-processing services,
66	including, but not limited to:
67	1. Negotiating rebates, discounts, or other financial
68	incentives and arrangements with drug companies.
69	2. Disbursing or distributing rebates.
70	3. Managing or participating in incentive programs or
71	arrangements for pharmacist's services.
72	4. Negotiating or entering into contractual arrangements
73	with pharmacists or pharmacies, or both.
74	5. Developing formularies.
75	6. Designing prescription benefit programs.
76	7. Advertising or promoting claims-processing services or
77	other prescription drug or device services.
78	(h) "Pharmacist" means an individual licensed as a
79	pharmacist under this chapter.
80	(i) "Pharmacist's services" means the practice of the
81	profession of pharmacy as defined in s. 465.003.
82	(j) "Pharmacy" means pharmacy as defined in s. 465.003.
83	(k)1. "Pharmacy benefit manager" means a person, business,
84	or other entity, and any wholly or partially owned or controlled
85	subsidiary of a pharmacy benefit manager, that provides claims-
86	processing services or other prescription drug or device
87	services, or both, to third parties.
88	2. "Pharmacy benefit manager" does not include licensed
89	health care facilities, pharmacies, licensed health care
90	professionals, insurance companies, unions, or health
91	maintenance organizations.
92	(l) "Single-source drug" means a drug that is not a multi-
93	source drug.
94	(m)1. "Third parties" means any person, business, or other
95	entity other than a pharmacy benefit manager.
96	2. "Third parties" does not include:
97	a. A person, business, or other entity that owns or holds
98	a controlling interest in the pharmacy benefit manager; or
99	b. A person, business, or other entity in which the
100	pharmacy benefit manager owns or holds a controlling interest.
101	(n) "Usual and customary price" means the price that a
102	pharmacist or pharmacy would have charged cash-paying patients,
103	excluding patients for whom reimbursement rates are set by
104	contract, for the same services on the same date.
105	(4) CERTIFICATE OF AUTHORITY.--
106	(a)1. No person or organization shall establish or operate
107	as a pharmacy benefit manager in this state without obtaining a
108	certificate of authority from the board in accordance with this
109	section and all applicable federal and state laws.
110	2. A pharmacy benefit manager doing business in this state
111	shall obtain a certificate of authority from the board within
112	120 days after the effective date of this section and every 2
113	years thereafter. The certificate of authority shall expire on
114	December 31 in the year following the year the certificate of
115	authority was first issued and then may be renewed for
116	successive 2-year periods.
117	(b)1. Any organization or person may apply to the board to
118	obtain a certificate of authority to establish and operate a
119	pharmacy benefit manager under this section.
120	2. A nonrefundable application fee of $300, payable to the
121	board, shall accompany each application for a certificate of
122	authority and each application for renewal of a certificate of
123	authority.
124	(c) The board shall not issue a certificate of authority
125	to any pharmacy benefit manager until the board is satisfied
126	that the pharmacy benefit manager:
127	1. Holds a current license issued by the office to do
128	business in this state as a pharmacy benefit manager.
129	2. Is ready and able to arrange for pharmacist's services
130	in this state.
131	3. Meets the requirements set forth in this section and in
132	rules adopted under this section.
133	4. Is in compliance with all applicable state and federal
134	laws and regulations.
135	(d) The board may suspend or revoke any certificate of
136	authority issued to a pharmacy benefit manager under this
137	section, deny an application for a certificate of authority to
138	an applicant, or deny an application for renewal of a
139	certificate of authority if it finds that:
140	1. The pharmacy benefit manager is operating materially in
141	contravention of:
142	a. Its application or other information submitted as a
143	part of its application for a certificate of authority or
144	renewal of its certificate of authority; or
145	b. Any condition imposed by the board with regard to the
146	issuance or renewal of its certificate of authority;
147	2. The pharmacy benefit manager does not arrange for
148	pharmacist's services;
149	3. The pharmacy benefit manager has failed to continuously
150	meet the requirements for issuance of a certificate of authority
151	as set forth in this section or any rules adopted under this
152	section;
153	4. The pharmacy benefit manager has otherwise failed to
154	substantially comply with this section or any rules adopted
155	under this section;
156	5. The continued operation of the pharmacy benefit manager
157	may be hazardous to patients; or
158	6. The pharmacy benefit manager has failed to
159	substantially comply with any applicable state or federal law or
160	regulation.
161	(e)1. When the certificate of authority of a pharmacy
162	benefit manager is revoked, the manager shall:
163	a. Proceed, immediately following the effective date of
164	the order of revocation, to wind up its affairs.
165	b. Conduct no further business except as may be essential
166	to the orderly conclusion of its affairs.
167	2. The board may permit any further operation of the
168	pharmacy benefit manager as the board may find to be in the best
169	interest of patients to the end that patients will have the
170	greatest practical opportunity to obtain pharmacist's services.
171	(5) LICENSE TO DO BUSINESS.--
172	(a)1. No person or organization shall establish or operate
173	as a pharmacy benefit manager in this state without first
174	obtaining a license from the office in accordance with this
175	section and all applicable federal and state laws.
176	2. A pharmacy benefit manager doing business in this state
177	shall obtain a license from the office within 60 days after the
178	effective date of this section and each year thereafter.
179	(b)1. An application for a license to operate in this
180	state as a pharmacy benefit manager shall be in a form
181	prescribed by the office and shall be verified by an officer or
182	authorized representative of the pharmacy benefit manager.
183	2. The application shall include at least the following:
184	a. All organizational documents, including, but not
185	limited to, articles of incorporation, bylaws, and other similar
186	documents and any amendments.
187	b. The names, addresses, and titles of individuals
188	responsible for the business and services provided, including
189	all claims-processing services and other prescription drug or
190	device services.
191	c. The names, addresses, titles, and qualifications of the
192	members and officers of the board of directors, board of
193	trustees, or other governing body or committee, or the partners
194	or owners in case of a partnership, other entity, or
195	association.
196	d. A detailed description of the claims-processing
197	services and other prescription drug or device services provided
198	or to be provided.
199	e. The name and address of the agent for service of
200	process in this state.
201	f. Financial statements for the current and the preceding
202	year showing the assets, liabilities, direct or indirect income,
203	and any other sources of financial support sufficient, as deemed
204	by the office, to show financial stability and viability to meet
205	its full obligations to pharmacies and pharmacists.
206	g. A bond in an amount determined by the office by rule to
207	ensure that funds received by the pharmacy benefit manager for
208	pharmacist's services are, in fact, paid to appropriate
209	pharmacies and pharmacists.
210	h. All incentive arrangements or programs such as rebates,
211	discounts, disbursements, or any other similar financial program
212	or arrangement relating to income or consideration received or
213	negotiated, directly or indirectly, with any pharmaceutical
214	company that relates to other prescription drug or device
215	services, including, but not limited to:
216	(I) Information on the formula or other method for
217	calculation and amount of the incentive arrangements, rebates,
218	or other disbursements.
219	(II) The identity of the associated drug or device.
220	(III) The dates and amounts of the disbursements.
221	i. Other information as the office may require.
222	(c) The office shall not issue an annual pharmacy benefit
223	manager license to do business in this state to any pharmacy
224	benefit manager until the office is satisfied that the pharmacy
225	benefit manager has:
226	1. Paid all fees, taxes, and charges required by law.
227	2. Filed a financial statement or statements and any
228	reports, certificates, or other documents the office considers
229	necessary to secure a full and accurate knowledge of the
230	pharmacy benefit manager's affairs and financial condition.
231	3.a. Established its solvency.
232	b. Satisfied the office that the pharmacy benefit
233	manager's financial condition, method of operation, and manner
234	of doing business make it possible for the pharmacy benefit
235	manager to meet its obligations to pharmacies and pharmacists.
236	4. Otherwise complied with all the requirements of law.
237	5. Obtained a bond in an amount determined by the office
238	to ensure that funds received by the pharmacy benefit manager
239	for pharmacist's services are, in fact, paid to appropriate
240	pharmacies and pharmacists.
241	(d)1. The annual pharmacy benefit manager license shall be
242	in addition to the certificate of authority issued by the board.
243	2. A nonrefundable license application fee of $500 shall
244	accompany each application for a license to transact business in
245	this state.
246	3. The fee shall be collected by the office and paid
247	directly into the Insurance Commissioner's Regulatory Trust Fund
248	to provide expenses for the regulation, supervision, and
249	examination of all entities subject to regulation under this
250	section.
251	(e) The pharmacy benefit manager license shall be signed
252	by the office or an authorized agent of the office and shall
253	expire 1 year after the date the license becomes effective.
254	(f)1. A pharmacy benefit manager transacting business in
255	this state shall obtain an annual renewal of its license from
256	the office.
257	2. The office may refuse to renew the license of any
258	pharmacy benefit manager or may renew the license, subject to
259	any restrictions considered appropriate by the office, if the
260	office finds that the pharmacy benefit manager has not satisfied
261	all the conditions stated in this section.
262	3.a. Before denying renewal of a license, the office shall
263	provide the pharmacy benefit manager:
264	(I) At least 10 days' advance notice of the denial.
265	(II) An opportunity to appear at a formal or informal
266	hearing.
267	b. The office and the pharmacy benefit manager may jointly
268	waive the required notice.
269	(6) RULES.--
270	(a) The board may adopt rules not inconsistent with this
271	section regulating pharmacy benefit managers with regard to
272	professional, public health, and public safety issues.
273	(b) The office may adopt rules not inconsistent with this
274	section regulating pharmacy benefit managers with regard to
275	business and financial issues.
276	(c) Rules adopted under this section may set penalties,
277	including, but not limited to, monetary fines, for violations of
278	this section and rules adopted under this section.
279	(7) ANNUAL STATEMENT.--
280	(a)1. A pharmacy benefit manager doing business in this
281	state shall file a statement with the office annually by March
282	1.
283	2. The statement shall be verified by at least two
284	principal officers of the pharmacy benefit manager and shall
285	cover the preceding calendar year.
286	(b) The statement shall be on forms prescribed by the
287	office and shall include:
288	1. A financial statement of the organization, including
289	its balance sheet and income statement for the preceding year.
290	2. The number and dollar value of claims for pharmacist's
291	services processed by the pharmacy benefit manager during the
292	preceding year with respect to patients who are residents of
293	this state.
294	3. Any other information relating to the operations of the
295	pharmacy benefit manager required by the office.
296	(c) If a pharmacy benefit manager is audited annually by
297	an independent certified public accountant, a copy of each
298	certified audit report shall be promptly filed with the office.
299	(d)1. The office may extend the time prescribed for any
300	pharmacy benefit manager for filing annual statements or other
301	reports or exhibits for good cause shown.
302	2. The office may not extend the time for filing annual
303	statements beyond 60 days after the time prescribed in this
304	section.
305	3. Until the annual statement is filed, the office may
306	revoke or suspend the license of a pharmacy benefit manager that
307	fails to file its annual statement within the time prescribed by
308	this section.
309	(8) FINANCIAL EXAMINATION.--
310	(a)1. The office shall regularly conduct financial
311	examinations of all pharmacy benefit managers doing business in
312	this state pursuant to a schedule and in a manner established by
313	rule.
314	2. The examination shall verify:
315	a. The financial ability of the pharmacy benefit manager
316	to meet its full obligations to pharmacies and pharmacists.
317	b. Information submitted to the office as a part of an
318	application for a license or renewal of a license.
319	c. Compliance with this section.
320	(b) In lieu of, or in addition to, making the financial
321	examination of a pharmacy benefit manager, the office may accept
322	the report of a financial examination of the pharmacy benefit
323	manager under the laws of another state certified by its
324	insurance office, similar regulatory agency, or state health
325	agency to the extent that the report of financial examination
326	covers the minimum requirements specified in paragraph (a).
327	(c)1. The office shall coordinate financial examinations
328	of pharmacy benefit managers to ensure an appropriate level of
329	regulatory oversight and to avoid any undue duplication of
330	effort or regulation.
331	2. The pharmacy benefit manager being examined shall pay
332	the cost of the examination.
333	3. The cost of the examination shall be deposited into the
334	Insurance Commissioner's Regulatory Trust Fund to provide all
335	expenses for the regulation, supervision, and examination of all
336	entities subject to regulation under this section.
337	(9) ASSESSMENT.--
338	(a) Except as provided in subparagraph (8)(c)3., the
339	expense of administering this section incurred by the office
340	shall be assessed annually by the office against all pharmacy
341	benefit managers operating in this state.
342	(b) The office shall assess each pharmacy benefit manager
343	annually for its share of the office's estimated expenses with
344	regard to this section in proportion to the business done in
345	this state, as determined by the office in the office's
346	reasonable discretion.
347	(c)1. The office shall give each pharmacy benefit manager
348	notice of the assessment, which shall be paid to the office
349	before March 2 of each year.
350	2. A pharmacy benefit manager that fails to pay the
351	assessment before March 2 of each year shall be subject to a
352	penalty imposed by the office.
353	3. The penalty shall be 10 percent of the assessment plus
354	interest for the period between the due date and the date of
355	full payment.
356	4. If a payment is made in an amount later found to be in
357	error, the office shall:
358	a. If an additional amount is due:
359	(I) Notify the pharmacy benefit manager of the additional
360	amount due.
361	(II) Order the pharmacy benefit manager to pay the
362	additional amount within 14 days after the date of the notice.
363	b. If an overpayment is made, order a refund to the
364	pharmacy benefit manager.
365	(d)1. If an assessment made under this section is not paid
366	to the office by the prescribed date, the amount of the
367	assessment, plus any penalty, may be recovered from the
368	defaulting pharmacy benefit manager on motion of the office made
369	in the name and for the use of the State of Florida in the
370	Circuit Court of Leon County, after 10 days' notice to the
371	pharmacy benefit manager.
372	2. The license of any defaulting pharmacy benefit manager
373	to transact business in this state may be revoked or suspended
374	by the office until the pharmacy benefit manager has paid the
375	assessment.
376	(e) All fees assessed under this section and paid to the
377	office shall be deposited into the Insurance Commissioner's
378	Regulatory Trust Fund to provide all expenses for the
379	regulation, supervision, and examination by the office of all
380	entities subject to regulation under this section.
381	(f) If a pharmacy benefit manager becomes insolvent or
382	ceases to do business in this state in any assessable or license
383	year, the pharmacy benefit manager shall remain liable for the
384	payment of the assessment for the period in which it operated as
385	a pharmacy benefit manager in this state.
386	(10) PHARMACY BENEFIT MANAGER CONTRACTS.--
387	(a)1. A pharmacy benefit manager that contracts with a
388	pharmacy or pharmacist to provide pharmacist's services in this
389	state shall first inform the pharmacy or pharmacist in writing
390	of the number of, and other relevant information concerning,
391	patients to be served by the pharmacy or pharmacist under the
392	contract.
393	2. There shall be a separate contract with each pharmacy
394	or pharmacist for each of the pharmacy benefit manager's
395	provider networks.
396	3. Contracts providing for indemnity of the pharmacy or
397	pharmacist shall be separate from contracts providing for cash
398	discounts.
399	4. A pharmacy benefit manager shall not require that a
400	pharmacy or pharmacist participate in one contract in order to
401	participate in another contract.
402	(b) Each pharmacy benefit manager shall provide contracts
403	to the pharmacies and pharmacists that are written in plain
404	English, using terms that will be generally understood by
405	pharmacists.
406	(c) All contracts between a pharmacy benefit manager and a
407	pharmacy or pharmacist shall provide specific time limits for
408	the pharmacy benefit manager to pay the pharmacy or pharmacist
409	for pharmacist's services rendered.
410	(d) No pharmacy benefit manager contract may mandate that
411	any pharmacy or pharmacist change a patient's maintenance drug
412	unless the prescribing practitioner so orders.
413	(e)1. In handling moneys received by the pharmacy benefit
414	manager for pharmacist's services, the pharmacy benefit manager
415	acts as a fiduciary of the pharmacy, pharmacist, or both, that
416	provided the pharmacist's services.
417	2. A pharmacy benefit manager shall distribute all moneys
418	the pharmacy benefit manager receives for pharmacist's services
419	to the pharmacies and pharmacists that provided the pharmacist's
420	services and shall do so within a time established by the
421	office.
422	(f)1. A pharmacy benefit manager that contracts with a
423	pharmacy or pharmacist to provide pharmacist's services in this
424	state shall file the contract forms with the office 30 days
425	before the execution of the contract.
426	2.a. The contract forms are approved unless the office
427	disapproves the contract forms within 30 days after filing with
428	the office.
429	b. Disapproval shall be in writing, stating the reasons
430	for the disapproval, and a copy shall be delivered to the
431	pharmacy benefit manager.
432	c. The office shall develop formal criteria for the
433	approval and disapproval of pharmacy benefit manager contract
434	forms.
435	(g)1. A pharmacy benefit manager that initiates an audit
436	of a pharmacy or pharmacist under the contract shall limit the
437	audit to methods and procedures that are recognized as fair and
438	equitable for both the pharmacy benefit manager and the pharmacy
439	or pharmacist, or both.
440	2. Extrapolation calculations in an audit are prohibited.
441	3. A pharmacy benefit manager may not recoup any moneys
442	due from an audit by setoff from future remittances until the
443	results of the audit are finalized.
444	(h) Before terminating a pharmacy or pharmacist from a
445	pharmacy benefit manager's provider network, the pharmacy
446	benefit manager shall give the pharmacy or pharmacist a written
447	explanation of the reason for the termination 30 days before the
448	actual termination unless the termination is taken in reaction
449	to:
450	1. Loss of license;
451	2. Loss of professional liability insurance; or
452	3. Conviction of fraud or misrepresentation.
453	(i)1. No pharmacy or pharmacist may be held responsible
454	for the acts or omissions of a pharmacy benefit manager.
455	2. No pharmacy benefit manager may be held responsible for
456	the acts or omissions of a pharmacy or pharmacist.
457	(11) ENFORCEMENT.--
458	(a)1. Enforcement of this section shall be the
459	responsibility of the board and the office.
460	2. The board or the office, or both, shall take action or
461	impose appropriate penalties to bring a noncomplying pharmacy
462	benefit manager into full compliance with this section or shall
463	terminate the pharmacy benefit manager's certificate of
464	authority or license.
465	(b)1. The board and the office shall each adopt procedures
466	for formal investigation of complaints concerning the failure of
467	a pharmacy benefit manager to comply with this section.
468	2.a. The office may refer a complaint received under this
469	section to the board if the complaint involves a professional or
470	patient health or safety issue.
471	b. The board may refer a complaint received under this
472	section to the office if the complaint involves a business or
473	financial issue.
474	3.a. If the board or the office has reason to believe that
475	there may have been a violation of this section, the board or
476	office shall issue and serve upon the pharmacy benefit manager a
477	statement of the charges and a notice of a hearing.
478	b. The hearing shall be held at a time and place fixed in
479	the notice, and not be less than 30 days after the notice is
480	served.
481	c. At the hearing, the pharmacy benefit manager shall have
482	an opportunity to be heard and to show cause why the board or
483	the office should not:
484	(I) Issue a cease and desist order against the pharmacy
485	benefit manager; or
486	(II) Take any other necessary or appropriate action,
487	including, but not limited to, termination of the pharmacy
488	benefit manager's certificate of authority or license.
489	(c)1. The board may conduct an investigation concerning
490	the quality of services of any pharmacy benefit manager,
491	pharmacy, or pharmacist with whom the pharmacy benefit manager
492	has contracts, as the board deems necessary for the protection
493	of the interests of the residents of this state.
494	2. In addition to applying penalties and remedies under
495	this section for a pharmacy benefit manager's violation of this
496	section, the board may also apply penalties and remedies under
497	any provision of state law for violation thereof.
498	(12) MEDICATION REIMBURSEMENT COSTS.--
499	(a) Pharmacy benefit managers shall use a current
500	nationally recognized benchmark to base reimbursements for
501	medications and products dispensed by pharmacies or pharmacists
502	with whom the pharmacy benefit manager contracts as follows:
503	1. For brand single-source drugs and brand multi-source
504	drugs, either the Average Wholesale Price as listed in First
505	Data Bank (Hearst Publications) or Facts & Comparisons (formerly
506	Medispan) shall be used as an index.
507	2. For generic multi-source drugs, maximum allowable costs
508	shall be established by referencing the Baseline Price as listed
509	in either First Data Bank or Facts & Comparisons.
510	a. Only products that are in compliance with pharmacy laws
511	as equivalent and generically interchangeable with a United
512	States Food and Drug Administration Orange Book rating of A-B
513	may be reimbursed from a maximum allowable cost price
514	methodology.
515	b. If a generic multi-source drug product has no baseline
516	price, then it shall be treated as a brand single-source drug
517	for the purpose of valuing reimbursement.
518	(b) If the publications specified in paragraph (a) cease
519	to be nationally recognized benchmarks used to base
520	reimbursement for medications and products dispensed by
521	pharmacies and pharmacists, other current nationally recognized
522	benchmarks, as are then current and in effect, may be utilized
523	so long as the benchmark is established and published by a
524	person, business, or other entity with which no pharmacy benefit
525	manager has a financial or business interest or connection.
526	(13) PROHIBITED PRACTICES.--
527	(a) Neither a pharmacy benefit manager nor a
528	representative of a pharmacy benefit manager may cause or
529	knowingly permit the use of any advertisement, promotion,
530	solicitation, proposal, or offer that is untrue, deceptive, or
531	misleading.
532	(b) A pharmacy benefit manager may not discriminate on the
533	basis of race, creed, color, sex, or religion in the selection
534	of pharmacies or pharmacists with which the pharmacy benefit
535	manager contracts.
536	(c) A pharmacy benefit manager may not unreasonably
537	discriminate against or between pharmacies or pharmacists.
538	(d) A pharmacy benefit manager shall be entitled to access
539	a pharmacy's or pharmacist's usual and customary price only for
540	comparison to specific claims for payment made by the pharmacy
541	or pharmacist to the pharmacy benefit manager, and any other use
542	or disclosure by the pharmacy benefit manager is prohibited.
543	(e) A pharmacy benefit manager may not, directly or
544	indirectly, overtly or covertly, in cash or in kind, receive or
545	accept any rebate, kickback, or any special payment, favor, or
546	advantage of any valuable consideration or inducement for
547	influencing or switching a patient's drug product unless the
548	rebate, kickback, payment, favor, valuable consideration, or
549	inducement is specified in a written contract that has been
550	filed with the office.
551	(f)1. Claims for pharmacist's services paid by a pharmacy
552	benefit manager may not be retroactively denied or adjusted
553	after adjudication of the claims, unless:
554	a. The original claim was submitted fraudulently;
555	b. The original claim payment was incorrect because the
556	pharmacy or pharmacist had already been paid for the
557	pharmacist's services; or
558	c. The pharmacist's services were not, in fact, rendered
559	by the pharmacy or pharmacist.
560	2. An acknowledgement of eligibility may not be
561	retroactively reversed.
562	(g) A pharmacy benefit manager may not terminate a
563	contract with a pharmacy or pharmacist, or terminate, suspend,
564	or otherwise limit the participation of a pharmacy or pharmacist
565	in a pharmacy benefit manager's provider network, because:
566	1. The pharmacy or pharmacist expresses disagreement with
567	the pharmacy benefit manager's decision to deny or limit
568	benefits to a patient;
569	2. The pharmacist discusses with a patient any aspect of
570	the patient's medical condition or treatment alternatives;
571	3. The pharmacist makes personal recommendations regarding
572	selecting a pharmacy benefit manager based on the pharmacist's
573	personal knowledge of the health needs of the patient;
574	4. The pharmacy or pharmacist protests or expresses
575	disagreement with a decision, policy, or practice of the
576	pharmacy benefit manager;
577	5. The pharmacy or pharmacist has in good faith
578	communicated with or advocated on behalf of any patient related
579	to the needs of the patient regarding the method by which the
580	pharmacy or pharmacist is compensated for services provided
581	under the contract with the pharmacy benefit manager;
582	6. The pharmacy or pharmacist complains to the board or
583	office that the pharmacy benefit manager has failed to comply
584	with this section; or
585	7. The pharmacy or pharmacist asserts rights under the
586	contract with the pharmacy benefit manager.
587	(h) Termination of a contract between a pharmacy benefit
588	manager and a pharmacy or pharmacist, or termination of a
589	pharmacy or pharmacist from a pharmacy benefit manager's
590	provider network, shall not release the pharmacy benefit manager
591	from the obligation to make any payment due to the pharmacy or
592	pharmacist for pharmacist's services rendered.
593	(i) A pharmacy benefit manager may not intervene in the
594	delivery or transmission of prescriptions from the prescriber to
595	the pharmacist or pharmacy for the purpose of:
596	1. Influencing the prescriber's choice of therapy;
597	2. Influencing the patient's choice of pharmacist or
598	pharmacy; or
599	3. Altering the prescription information, including, but
600	not limited to, switching the prescribed drug without the
601	express written authorization of the prescriber.
602	(j) A pharmacy benefit manager may not engage in or
603	interfere with the practice of medicine or intervene in the
604	practice of medicine between prescribers and their patients.
605	(k) A pharmacy benefit manager may not engage in any
606	activity that violates any requirement of Florida law.
607	(14) NO IMPAIRMENT OF EXISTING CONTRACTS.--To avoid
608	impairment of existing contracts, this section shall apply only
609	to contracts entered into or renewed after the effective date of
610	this section.
611	(15) SUPPLEMENTAL NATURE.--This section is supplemental to
612	all other laws and supersedes only those laws or parts of laws
613	in direct conflict with it.
614	Section 2. This act shall take effect upon becoming a law.
615
616