Florida Senate - 2017 COMMITTEE AMENDMENT Bill No. CS for SB 182 Ì284826AÎ284826 LEGISLATIVE ACTION Senate . House Comm: RS . 02/22/2017 . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— The Committee on Health Policy (Mayfield) recommended the following: 1 Senate Amendment (with title amendment) 2 3 Delete everything after the enacting clause 4 and insert: 5 Section 1. Paragraph (k) is added to subsection (3) of 6 section 110.123, Florida Statutes, to read: 7 110.123 State group insurance program.— 8 (3) STATE GROUP INSURANCE PROGRAM.— 9 (k) Sections 627.42393 and 641.31(36)(a) do not apply to 10 the state group insurance program. 11 Section 2. Section 627.42393, Florida Statutes, is created 12 to read: 13 627.42393 Insurance policies; limiting changes to 14 prescription drug formularies.— 15 (1) Other than at the time of coverage renewal, an 16 individual or group insurance policy that is delivered, issued 17 for delivery, renewed, amended, or continued in this state and 18 that provides medical, major medical, or similar comprehensive 19 coverage may not: 20 (a) Remove a covered prescription drug from its list of 21 covered drugs during the policy year unless the United States 22 Food and Drug Administration has issued a statement about the 23 drug which calls into question the clinical safety of the drug, 24 or the manufacturer of the drug has notified the United States 25 Food and Drug Administration of a manufacturing discontinuance 26 or potential discontinuance of the drug as required by s. 506C 27 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c. 28 (b) Reclassify a drug to a more restrictive drug tier or 29 increase the amount that an insured must pay for a copayment, 30 coinsurance, or deductible for prescription drug benefits, or 31 reclassify a drug to a higher cost-sharing tier during the 32 policy year. 33 (2) This section does not prohibit the addition of 34 prescription drugs to the list of drugs covered under the policy 35 during the policy year. 36 (3) This section does not apply to a grandfathered health 37 plan as defined in s. 627.402 or to benefits set forth in s. 38 627.6513(1)-(14). 39 (4) This section does not alter or amend s. 465.025, which 40 provides conditions under which a pharmacist may substitute a 41 generically equivalent drug product for a brand name drug 42 product. 43 (5) This section does not alter or amend s. 465.0252, which 44 provides conditions under which a pharmacist may dispense a 45 substitute biological product for the prescribed biological 46 product. 47 Section 3. Paragraph (e) of subsection (5) of section 48 627.6699, Florida Statutes, is amended to read: 49 627.6699 Employee Health Care Access Act.— 50 (5) AVAILABILITY OF COVERAGE.— 51 (e) All health benefit plans issued under this section must 52 comply with the following conditions: 53 1. For employers who have fewer than two employees, a late 54 enrollee may be excluded from coverage for no longer than 24 55 months if he or she was not covered by creditable coverage 56 continually to a date not more than 63 days before the effective 57 date of his or her new coverage. 58 2. Any requirement used by a small employer carrier in 59 determining whether to provide coverage to a small employer 60 group, including requirements for minimum participation of 61 eligible employees and minimum employer contributions, must be 62 applied uniformly among all small employer groups having the 63 same number of eligible employees applying for coverage or 64 receiving coverage from the small employer carrier, except that 65 a small employer carrier that participates in, administers, or 66 issues health benefits pursuant to s. 381.0406 which do not 67 include a preexisting condition exclusion may require as a 68 condition of offering such benefits that the employer has had no 69 health insurance coverage for its employees for a period of at 70 least 6 months. A small employer carrier may vary application of 71 minimum participation requirements and minimum employer 72 contribution requirements only by the size of the small employer 73 group. 74 3. In applying minimum participation requirements with 75 respect to a small employer, a small employer carrier shall not 76 consider as an eligible employee employees or dependents who 77 have qualifying existing coverage in an employer-based group 78 insurance plan or an ERISA qualified self-insurance plan in 79 determining whether the applicable percentage of participation 80 is met. However, a small employer carrier may count eligible 81 employees and dependents who have coverage under another health 82 plan that is sponsored by that employer. 83 4. A small employer carrier shall not increase any 84 requirement for minimum employee participation or any 85 requirement for minimum employer contribution applicable to a 86 small employer at any time after the small employer has been 87 accepted for coverage, unless the employer size has changed, in 88 which case the small employer carrier may apply the requirements 89 that are applicable to the new group size. 90 5. If a small employer carrier offers coverage to a small 91 employer, it must offer coverage to all the small employer’s 92 eligible employees and their dependents. A small employer 93 carrier may not offer coverage limited to certain persons in a 94 group or to part of a group, except with respect to late 95 enrollees. 96 6. A small employer carrier may not modify any health 97 benefit plan issued to a small employer with respect to a small 98 employer or any eligible employee or dependent through riders, 99 endorsements, or otherwise to restrict or exclude coverage for 100 certain diseases or medical conditions otherwise covered by the 101 health benefit plan. 102 7. An initial enrollment period of at least 30 days must be 103 provided. An annual 30-day open enrollment period must be 104 offered to each small employer’s eligible employees and their 105 dependents. A small employer carrier must provide special 106 enrollment periods as required by s. 627.65615. 107 8. A small employer carrier must limit changes to 108 prescription drug formularies as required by s. 627.42393. 109 Section 4. Subsection (36) of section 641.31, Florida 110 Statutes, is amended to read: 111 641.31 Health maintenance contracts.— 112 (36) A health maintenance organization may increase the 113 copayment for any benefit, or delete, amend, or limit any of the 114 benefits to which a subscriber is entitled under the group 115 contract only, upon written notice to the contract holder at 116 least 45 days in advance of the time of coverage renewal. The 117 health maintenance organization may amend the contract with the 118 contract holder, with such amendment to be effective immediately 119 at the time of coverage renewal. The written notice to the 120 contract holder must
shallspecifically identify any deletions, 121 amendments, or limitations to any of the benefits provided in 122 the group contract during the current contract period which will 123 be included in the group contract upon renewal. This subsection 124 does not apply to any increases in benefits. The 45-day notice 125 requirement does shallnot apply if benefits are amended, 126 deleted, or limited at the request of the contract holder. 127 (a) Other than at the time of coverage renewal, a health 128 maintenance organization that provides medical, major medical, 129 or similar comprehensive coverage may not: 130 1. Remove a covered prescription drug from its list of 131 covered drugs during the contract year unless the United States 132 Food and Drug Administration has issued a statement about the 133 drug which calls into question the clinical safety of the drug, 134 or the manufacturer of the drug has notified the United States 135 Food and Drug Administration of a manufacturing discontinuance 136 or potential discontinuance of the drug as required by s. 506C 137 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c. 138 2. Reclassify a drug to a more restrictive drug tier or 139 increase the amount that an insured must pay for a copayment, 140 coinsurance, or deductible for prescription drug benefits, or 141 reclassify a drug to a higher cost-sharing tier during the 142 contract year. 143 (b) This subsection does not: 144 1. Prohibit the addition of prescription drugs to the list 145 of drugs covered during the contract year. 146 2. Apply to a grandfathered health plan as defined in s. 147 627.402 or to benefits set forth in s. 627.6513(1)-(14). 148 3. Alter or amend s. 465.025, which provides conditions 149 under which a pharmacist may substitute a generically equivalent 150 drug product for a brand name drug product. 151 4. Alter or amend s. 465.0252, which provides conditions 152 under which a pharmacist may dispense a substitute biological 153 product for the prescribed biological product. 154 Section 5. The Legislature finds that this act fulfills an 155 important state interest. 156 Section 6. This act shall take effect January 1, 2018. 157 158 ================= T I T L E A M E N D M E N T ================ 159 And the title is amended as follows: 160 Delete everything before the enacting clause 161 and insert: 162 A bill to be entitled 163 An act relating to consumer protection from nonmedical 164 changes to prescription drug formularies; amending s. 165 110.123, F.S.; providing that certain provisions 166 prohibiting nonmedical changes to prescription drug 167 formularies do not apply to the state group insurance 168 program; creating s. 627.42393, F.S.; limiting, under 169 specified circumstances, changes to a health insurance 170 policy prescription drug formulary during a policy 171 year; providing construction and applicability; 172 amending s. 627.6699, F.S.; requiring small employer 173 carriers to limit changes to prescription drug 174 formularies under certain circumstances; amending s. 175 641.31, F.S.; limiting, under specified circumstances, 176 changes to a health maintenance contract prescription 177 drug formulary during a contract year; providing 178 construction and applicability; providing a 179 declaration of important state interest; providing an 180 effective date.