Florida Senate - 2011                        COMMITTEE AMENDMENT
       Bill No. CS for SB 1972
                                Barcode 275242                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: WD            .                                
                  04/06/2011           .                                

       The Committee on Budget Subcommittee on Health and Human
       Services Appropriations (Sobel) recommended the following:
    1         Senate Amendment (with title amendment)
    3         Between lines 4394 and 4395
    4  insert:
    5         Section 52. Section 409.980, Florida Statutes, is created
    6  to read:
    7         409.980Prescribed drug services for qualified plans.—The
    8  agency shall ensure that a qualified plan has transparency and
    9  patient protections in its prescription drug benefit. The
   10  qualified plan must, at a minimum:
   11         (1) Make all meetings of the plan’s formulary committee
   12  open to the public and permit public comment before the
   13  committee establishes or modifies the plan’s formulary or
   14  preferred drug list or places any other restrictions or
   15  limitations on an enrollee’s access to prescription drugs.
   16         (2) Include at least two products, when available, in each
   17  therapeutic class.
   18         (3) Make available those drugs and dosage forms listed in
   19  its preferred drug list.
   20         (4) Make the prior-authorization process readily available
   21  to health care providers, including posting such process on its
   22  website.
   23         (5) Not arbitrarily deny or reduce the amount, duration, or
   24  scope of prescriptions solely based on the enrollee‘s diagnosis,
   25  type of illness, or condition. The qualified plan may place
   26  appropriate limits on prescriptions based on criteria such as
   27  medical necessity, or for the purpose of utilization control, if
   28  the plan reasonably expects such limits to achieve the purpose
   29  of the prescribed drug services set forth in the Medicaid state
   30  plan.
   31         (6) Make available those drugs not on its preferred drug
   32  list, when requested and approved, if drugs on the list have
   33  been used in a step therapy sequence or if other medical
   34  documentation is provided.
   35         (7) Cover the cost of a brand-name drug if the prescriber
   36  writes in his or her own handwriting on the prescription that
   37  the brand name is medically necessary and submits a completed
   38  multisource drug and miscellaneous prior authorization form to
   39  the qualified plan indicating that the enrollee has had an
   40  adverse reaction to a generic drug or has had, in the
   41  prescriber’s medical opinion, better results when taking the
   42  brand-name drug.
   43         (8) Ensure that antiretroviral agents are not subject to
   44  the preferred drug list.
   46  ================= T I T L E  A M E N D M E N T ================
   47         And the title is amended as follows:
   48         Delete line 251
   49  and insert:
   50         evaluation of dually eligible nursing home residents;
   51         creating s. 409.980, F.S.; providing minimum
   52         requirements for prescription drug benefits provided
   53         by a qualified plan;