Florida Senate - 2017 SENATOR AMENDMENT Bill No. CS for HB 161 Ì898364IÎ898364 LEGISLATIVE ACTION Senate . House . . . Floor: WD/2R . 05/04/2017 08:30 PM . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— Senator Mayfield moved the following: 1 Senate Amendment (with title amendment) 2 3 Delete line 82 4 and insert: 5 Section 2. Effective January 1, 2018, section 627.42393, 6 Florida Statutes, is created to read: 7 627.42393 Insurance policies; limiting changes to 8 prescription drug formularies.— 9 (1) Other than at the time of coverage renewal, an 10 individual or group insurance policy that is delivered, issued 11 for delivery, renewed, amended, or continued in this state and 12 that provides medical, major medical, or similar comprehensive 13 coverage may not: 14 (a) Remove a covered prescription drug from its list of 15 covered drugs during the policy year unless the United States 16 Food and Drug Administration has issued a statement about the 17 drug which calls into question the clinical safety of the drug, 18 or the manufacturer of the drug has notified the United States 19 Food and Drug Administration of a manufacturing discontinuance 20 or potential discontinuance of the drug as required by s. 506C 21 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c. 22 (b) Reclassify a drug to a more restrictive drug tier or 23 increase the amount that an insured must pay for a copayment, 24 coinsurance, or deductible for prescription drug benefits, or 25 reclassify a drug to a higher cost-sharing tier during the 26 policy year. 27 (2) This section does not prohibit the addition of 28 prescription drugs to the list of drugs covered under the policy 29 during the policy year. 30 (3) This section does not apply to a grandfathered health 31 plan as defined in s. 627.402 or to benefits set forth in s. 32 627.6513(1)-(14). 33 (4) This section does not alter or amend s. 465.025, which 34 provides conditions under which a pharmacist may substitute a 35 generically equivalent drug product for a brand name drug 36 product. 37 (5) This section does not alter or amend s. 465.0252, which 38 provides conditions under which a pharmacist may dispense a 39 substitute biological product for the prescribed biological 40 product. 41 Section 3. Effective January 1, 2018, Paragraph (e) of 42 subsection (5) of section 627.6699, Florida Statutes, is amended 43 to read: 44 627.6699 Employee Health Care Access Act.— 45 (5) AVAILABILITY OF COVERAGE.— 46 (e) All health benefit plans issued under this section must 47 comply with the following conditions: 48 1. For employers who have fewer than two employees, a late 49 enrollee may be excluded from coverage for no longer than 24 50 months if he or she was not covered by creditable coverage 51 continually to a date not more than 63 days before the effective 52 date of his or her new coverage. 53 2. Any requirement used by a small employer carrier in 54 determining whether to provide coverage to a small employer 55 group, including requirements for minimum participation of 56 eligible employees and minimum employer contributions, must be 57 applied uniformly among all small employer groups having the 58 same number of eligible employees applying for coverage or 59 receiving coverage from the small employer carrier, except that 60 a small employer carrier that participates in, administers, or 61 issues health benefits pursuant to s. 381.0406 which do not 62 include a preexisting condition exclusion may require as a 63 condition of offering such benefits that the employer has had no 64 health insurance coverage for its employees for a period of at 65 least 6 months. A small employer carrier may vary application of 66 minimum participation requirements and minimum employer 67 contribution requirements only by the size of the small employer 68 group. 69 3. In applying minimum participation requirements with 70 respect to a small employer, a small employer carrier shall not 71 consider as an eligible employee employees or dependents who 72 have qualifying existing coverage in an employer-based group 73 insurance plan or an ERISA qualified self-insurance plan in 74 determining whether the applicable percentage of participation 75 is met. However, a small employer carrier may count eligible 76 employees and dependents who have coverage under another health 77 plan that is sponsored by that employer. 78 4. A small employer carrier shall not increase any 79 requirement for minimum employee participation or any 80 requirement for minimum employer contribution applicable to a 81 small employer at any time after the small employer has been 82 accepted for coverage, unless the employer size has changed, in 83 which case the small employer carrier may apply the requirements 84 that are applicable to the new group size. 85 5. If a small employer carrier offers coverage to a small 86 employer, it must offer coverage to all the small employer’s 87 eligible employees and their dependents. A small employer 88 carrier may not offer coverage limited to certain persons in a 89 group or to part of a group, except with respect to late 90 enrollees. 91 6. A small employer carrier may not modify any health 92 benefit plan issued to a small employer with respect to a small 93 employer or any eligible employee or dependent through riders, 94 endorsements, or otherwise to restrict or exclude coverage for 95 certain diseases or medical conditions otherwise covered by the 96 health benefit plan. 97 7. An initial enrollment period of at least 30 days must be 98 provided. An annual 30-day open enrollment period must be 99 offered to each small employer’s eligible employees and their 100 dependents. A small employer carrier must provide special 101 enrollment periods as required by s. 627.65615. 102 8. A small employer carrier must limit changes to 103 prescription drug formularies as required by s. 627.42393. 104 Section 4. Effective January 1, 2018, subsection (36) of 105 section 641.31, Florida Statutes, is amended to read: 106 641.31 Health maintenance contracts.— 107 (36) A health maintenance organization may increase the 108 copayment for any benefit, or delete, amend, or limit any of the 109 benefits to which a subscriber is entitled under the group 110 contract only, upon written notice to the contract holder at 111 least 45 days in advance of the time of coverage renewal. The 112 health maintenance organization may amend the contract with the 113 contract holder, with such amendment to be effective immediately 114 at the time of coverage renewal. The written notice to the 115 contract holder must
shallspecifically identify any deletions, 116 amendments, or limitations to any of the benefits provided in 117 the group contract during the current contract period which will 118 be included in the group contract upon renewal. This subsection 119 does not apply to any increases in benefits. The 45-day notice 120 requirement does shallnot apply if benefits are amended, 121 deleted, or limited at the request of the contract holder. 122 (a) Other than at the time of coverage renewal, a health 123 maintenance organization that provides medical, major medical, 124 or similar comprehensive coverage may not: 125 1. Remove a covered prescription drug from its list of 126 covered drugs during the contract year unless the United States 127 Food and Drug Administration has issued a statement about the 128 drug which calls into question the clinical safety of the drug, 129 or the manufacturer of the drug has notified the United States 130 Food and Drug Administration of a manufacturing discontinuance 131 or potential discontinuance of the drug as required by s. 506C 132 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c. 133 2. Reclassify a drug to a more restrictive drug tier or 134 increase the amount that an insured must pay for a copayment, 135 coinsurance, or deductible for prescription drug benefits, or 136 reclassify a drug to a higher cost-sharing tier during the 137 contract year. 138 (b) This subsection does not: 139 1. Prohibit the addition of prescription drugs to the list 140 of drugs covered during the contract year. 141 2. Apply to a grandfathered health plan as defined in s. 142 627.402 or to benefits set forth in s. 627.6513(1)-(14). 143 3. Alter or amend s. 465.025, which provides conditions 144 under which a pharmacist may substitute a generically equivalent 145 drug product for a brand name drug product. 146 4. Alter or amend s. 465.0252, which provides conditions 147 under which a pharmacist may dispense a substitute biological 148 product for the prescribed biological product. 149 Section 5. The Legislature finds that the creation of s. 150 627.42393, Florida Statutes, and the amendments to ss. 627.6699 151 and 641.31, Florida Statutes, made by this act fulfill an 152 important state interest. 153 Section 6. Except as otherwise expressly provided in this 154 act, this act shall take effect July 1, 2017. 155 156 ================= T I T L E A M E N D M E N T ================ 157 And the title is amended as follows: 158 Delete lines 2 - 13 159 and insert: 160 An act relating to health care; creating s. 624.27, 161 F.S.; providing definitions; specifying that a direct 162 primary care agreement does not constitute insurance 163 and is not subject to the Florida Insurance Code; 164 specifying that entering into a direct primary care 165 agreement does not constitute the business of 166 insurance and is not subject to the code; providing 167 that a certificate of authority is not required to 168 market, sell, or offer to sell a direct primary care 169 agreement; specifying requirements for a direct 170 primary care agreement; creating s. 627.42393, F.S.; 171 limiting, under specified circumstances, changes to a 172 health insurance policy prescription drug formulary 173 during a policy year; providing construction and 174 applicability; amending s. 627.6699, F.S.; requiring 175 small employer carriers to limit changes to 176 prescription drug formularies under certain 177 circumstances; amending s. 641.31, F.S.; limiting, 178 under specified circumstances, changes to a health 179 maintenance contract prescription drug formulary 180 during a contract year; providing construction and 181 applicability; providing a declaration of important 182 state interest; providing effective dates.