Florida Senate - 2017 CS for SB 182 By the Committee on Banking and Insurance; and Senator Mayfield 597-01717-17 2017182c1 1 A bill to be entitled 2 An act relating to consumer protection from nonmedical 3 changes to prescription drug formularies; creating s. 4 627.42393, F.S.; limiting changes to a health 5 insurance policy prescription drug formulary during a 6 policy year; providing applicability and construction; 7 amending s. 627.6699, F.S.; requiring small employer 8 carriers to limit changes to prescription drug 9 formularies under certain circumstances; amending s. 10 641.31, F.S.; limiting changes to a health maintenance 11 contract prescription drug formulary during a contract 12 year; providing applicability and construction; 13 providing an effective date. 14 15 Be It Enacted by the Legislature of the State of Florida: 16 17 Section 1. Section 627.42393, Florida Statutes, is created 18 to read: 19 627.42393 Insurance policies; limiting changes to 20 prescription drug formularies.— 21 (1) Other than during an open enrollment period, an 22 individual or group insurance policy that is delivered, issued 23 for delivery, renewed, amended, or continued in this state and 24 that provides medical, major medical, or similar comprehensive 25 coverage may not: 26 (a) Remove a covered prescription drug from its list of 27 covered drugs during the policy year unless the United States 28 Food and Drug Administration has issued a statement about the 29 drug which calls into question the clinical safety of the drug, 30 or the manufacturer of the drug has notified the United States 31 Food and Drug Administration of a manufacturing discontinuance 32 or potential discontinuance of the drug as required by s. 506C 33 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c. 34 (b) Reclassify a drug to a more restrictive drug tier or 35 increase the amount that an insured must pay for a copayment, 36 coinsurance, or deductible for prescription drug benefits, or 37 reclassify a drug to a higher cost-sharing tier during the 38 policy year. 39 (2) This section does not prohibit the addition of 40 prescription drugs to the list of drugs covered under the policy 41 during the policy year. 42 (3) This section does not apply to a grandfathered health 43 plan as defined in s. 627.402 or to benefits set forth in s. 44 627.6513(1)-(14). 45 (4) This section does not alter or amend s. 465.025, which 46 provides conditions under which a pharmacist may substitute a 47 generically equivalent drug product for a brand name drug 48 product. 49 (5) This section does not alter or amend s. 465.0252, which 50 provides conditions under which a pharmacist may dispense a 51 substitute biological product for the prescribed biological 52 product. 53 Section 2. Paragraph (e) of subsection (5) of section 54 627.6699, Florida Statutes, is amended to read: 55 627.6699 Employee Health Care Access Act.— 56 (5) AVAILABILITY OF COVERAGE.— 57 (e) All health benefit plans issued under this section must 58 comply with the following conditions: 59 1. For employers who have fewer than two employees, a late 60 enrollee may be excluded from coverage for no longer than 24 61 months if he or she was not covered by creditable coverage 62 continually to a date not more than 63 days before the effective 63 date of his or her new coverage. 64 2. Any requirement used by a small employer carrier in 65 determining whether to provide coverage to a small employer 66 group, including requirements for minimum participation of 67 eligible employees and minimum employer contributions, must be 68 applied uniformly among all small employer groups having the 69 same number of eligible employees applying for coverage or 70 receiving coverage from the small employer carrier, except that 71 a small employer carrier that participates in, administers, or 72 issues health benefits pursuant to s. 381.0406 which do not 73 include a preexisting condition exclusion may require as a 74 condition of offering such benefits that the employer has had no 75 health insurance coverage for its employees for a period of at 76 least 6 months. A small employer carrier may vary application of 77 minimum participation requirements and minimum employer 78 contribution requirements only by the size of the small employer 79 group. 80 3. In applying minimum participation requirements with 81 respect to a small employer, a small employer carrier shall not 82 consider as an eligible employee employees or dependents who 83 have qualifying existing coverage in an employer-based group 84 insurance plan or an ERISA qualified self-insurance plan in 85 determining whether the applicable percentage of participation 86 is met. However, a small employer carrier may count eligible 87 employees and dependents who have coverage under another health 88 plan that is sponsored by that employer. 89 4. A small employer carrier shall not increase any 90 requirement for minimum employee participation or any 91 requirement for minimum employer contribution applicable to a 92 small employer at any time after the small employer has been 93 accepted for coverage, unless the employer size has changed, in 94 which case the small employer carrier may apply the requirements 95 that are applicable to the new group size. 96 5. If a small employer carrier offers coverage to a small 97 employer, it must offer coverage to all the small employer’s 98 eligible employees and their dependents. A small employer 99 carrier may not offer coverage limited to certain persons in a 100 group or to part of a group, except with respect to late 101 enrollees. 102 6. A small employer carrier may not modify any health 103 benefit plan issued to a small employer with respect to a small 104 employer or any eligible employee or dependent through riders, 105 endorsements, or otherwise to restrict or exclude coverage for 106 certain diseases or medical conditions otherwise covered by the 107 health benefit plan. 108 7. An initial enrollment period of at least 30 days must be 109 provided. An annual 30-day open enrollment period must be 110 offered to each small employer’s eligible employees and their 111 dependents. A small employer carrier must provide special 112 enrollment periods as required by s. 627.65615. 113 8. A small employer carrier must limit changes to 114 prescription drug formularies as required by s. 627.42393. 115 Section 3. Subsection (44) is added to section 641.31, 116 Florida Statutes, to read: 117 641.31 Health maintenance contracts.— 118 (44)(a) Other than during an open enrollment period, a 119 health maintenance contract that is delivered, issued for 120 delivery, renewed, amended, or continued in this state and that 121 provides medical, major medical, or similar comprehensive 122 coverage may not: 123 1. Remove a covered prescription drug from its list of 124 covered drugs during the contract year unless the United States 125 Food and Drug Administration has issued a statement about the 126 drug which calls into question the clinical safety of the drug, 127 or the manufacturer of the drug has notified the United States 128 Food and Drug Administration of a manufacturing discontinuance 129 or potential discontinuance of the drug as required by s. 506C 130 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c. 131 2. Reclassify a drug to a more restrictive drug tier or 132 increase the amount that an insured must pay for a copayment, 133 coinsurance, or deductible for prescription drug benefits, or 134 reclassify a drug to a higher cost-sharing tier during the 135 contract year. 136 (b) This subsection does not prohibit the addition of 137 prescription drugs to the list of drugs covered during the 138 contract year. 139 (c) This subsection does not apply to a grandfathered 140 health plan as defined in s. 627.402 or to benefits set forth in 141 s. 627.6513(1)-(14). 142 (d) This subsection does not alter or amend s. 465.025, 143 which provides conditions under which a pharmacist may 144 substitute a generically equivalent drug product for a brand 145 name drug product. 146 (e) This subsection does not alter or amend s. 465.0252, 147 which provides conditions under which a pharmacist may dispense 148 a substitute biological product for the prescribed biological 149 product. 150 Section 4. This act shall take effect January 1, 2018.