Florida Senate - 2017 CS for CS for SB 182 By the Committees on Health Policy; and Banking and Insurance; and Senator Mayfield 588-01933-17 2017182c2 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, under specified 5 circumstances, changes to a health insurance policy 6 prescription drug formulary during a policy year; 7 providing construction and applicability; amending s. 8 627.6699, F.S.; requiring small employer carriers to 9 limit changes to prescription drug formularies under 10 certain circumstances; amending s. 641.31, F.S.; 11 limiting, under specified circumstances, changes to a 12 health maintenance contract prescription drug 13 formulary during a contract year; providing 14 construction and applicability; providing a 15 declaration of important state interest; providing an 16 effective date. 17 18 Be It Enacted by the Legislature of the State of Florida: 19 20 Section 1. Section 627.42393, Florida Statutes, is created 21 to read: 22 627.42393 Insurance policies; limiting changes to 23 prescription drug formularies.— 24 (1) Other than at the time of coverage renewal, an 25 individual or group insurance policy that is delivered, issued 26 for delivery, renewed, amended, or continued in this state and 27 that provides medical, major medical, or similar comprehensive 28 coverage may not: 29 (a) Remove a covered prescription drug from its list of 30 covered drugs during the policy year unless the United States 31 Food and Drug Administration has issued a statement about the 32 drug which calls into question the clinical safety of the drug, 33 or the manufacturer of the drug has notified the United States 34 Food and Drug Administration of a manufacturing discontinuance 35 or potential discontinuance of the drug as required by s. 506C 36 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c. 37 (b) Reclassify a drug to a more restrictive drug tier or 38 increase the amount that an insured must pay for a copayment, 39 coinsurance, or deductible for prescription drug benefits, or 40 reclassify a drug to a higher cost-sharing tier during the 41 policy year. 42 (2) This section does not prohibit the addition of 43 prescription drugs to the list of drugs covered under the policy 44 during the policy year. 45 (3) This section does not apply to a grandfathered health 46 plan as defined in s. 627.402 or to benefits set forth in s. 47 627.6513(1)-(14). 48 (4) This section does not alter or amend s. 465.025, which 49 provides conditions under which a pharmacist may substitute a 50 generically equivalent drug product for a brand name drug 51 product. 52 (5) This section does not alter or amend s. 465.0252, which 53 provides conditions under which a pharmacist may dispense a 54 substitute biological product for the prescribed biological 55 product. 56 Section 2. Paragraph (e) of subsection (5) of section 57 627.6699, Florida Statutes, is amended to read: 58 627.6699 Employee Health Care Access Act.— 59 (5) AVAILABILITY OF COVERAGE.— 60 (e) All health benefit plans issued under this section must 61 comply with the following conditions: 62 1. For employers who have fewer than two employees, a late 63 enrollee may be excluded from coverage for no longer than 24 64 months if he or she was not covered by creditable coverage 65 continually to a date not more than 63 days before the effective 66 date of his or her new coverage. 67 2. Any requirement used by a small employer carrier in 68 determining whether to provide coverage to a small employer 69 group, including requirements for minimum participation of 70 eligible employees and minimum employer contributions, must be 71 applied uniformly among all small employer groups having the 72 same number of eligible employees applying for coverage or 73 receiving coverage from the small employer carrier, except that 74 a small employer carrier that participates in, administers, or 75 issues health benefits pursuant to s. 381.0406 which do not 76 include a preexisting condition exclusion may require as a 77 condition of offering such benefits that the employer has had no 78 health insurance coverage for its employees for a period of at 79 least 6 months. A small employer carrier may vary application of 80 minimum participation requirements and minimum employer 81 contribution requirements only by the size of the small employer 82 group. 83 3. In applying minimum participation requirements with 84 respect to a small employer, a small employer carrier shall not 85 consider as an eligible employee employees or dependents who 86 have qualifying existing coverage in an employer-based group 87 insurance plan or an ERISA qualified self-insurance plan in 88 determining whether the applicable percentage of participation 89 is met. However, a small employer carrier may count eligible 90 employees and dependents who have coverage under another health 91 plan that is sponsored by that employer. 92 4. A small employer carrier shall not increase any 93 requirement for minimum employee participation or any 94 requirement for minimum employer contribution applicable to a 95 small employer at any time after the small employer has been 96 accepted for coverage, unless the employer size has changed, in 97 which case the small employer carrier may apply the requirements 98 that are applicable to the new group size. 99 5. If a small employer carrier offers coverage to a small 100 employer, it must offer coverage to all the small employer’s 101 eligible employees and their dependents. A small employer 102 carrier may not offer coverage limited to certain persons in a 103 group or to part of a group, except with respect to late 104 enrollees. 105 6. A small employer carrier may not modify any health 106 benefit plan issued to a small employer with respect to a small 107 employer or any eligible employee or dependent through riders, 108 endorsements, or otherwise to restrict or exclude coverage for 109 certain diseases or medical conditions otherwise covered by the 110 health benefit plan. 111 7. An initial enrollment period of at least 30 days must be 112 provided. An annual 30-day open enrollment period must be 113 offered to each small employer’s eligible employees and their 114 dependents. A small employer carrier must provide special 115 enrollment periods as required by s. 627.65615. 116 8. A small employer carrier must limit changes to 117 prescription drug formularies as required by s. 627.42393. 118 Section 3. Subsection (36) of section 641.31, Florida 119 Statutes, is amended to read: 120 641.31 Health maintenance contracts.— 121 (36) A health maintenance organization may increase the 122 copayment for any benefit, or delete, amend, or limit any of the 123 benefits to which a subscriber is entitled under the group 124 contract only, upon written notice to the contract holder at 125 least 45 days in advance of the time of coverage renewal. The 126 health maintenance organization may amend the contract with the 127 contract holder, with such amendment to be effective immediately 128 at the time of coverage renewal. The written notice to the 129 contract holder must
shallspecifically identify any deletions, 130 amendments, or limitations to any of the benefits provided in 131 the group contract during the current contract period which will 132 be included in the group contract upon renewal. This subsection 133 does not apply to any increases in benefits. The 45-day notice 134 requirement does shallnot apply if benefits are amended, 135 deleted, or limited at the request of the contract holder. 136 (a) Other than at the time of coverage renewal, a health 137 maintenance organization that provides medical, major medical, 138 or similar comprehensive coverage may not: 139 1. Remove a covered prescription drug from its list of 140 covered drugs during the contract year unless the United States 141 Food and Drug Administration has issued a statement about the 142 drug which calls into question the clinical safety of the drug, 143 or the manufacturer of the drug has notified the United States 144 Food and Drug Administration of a manufacturing discontinuance 145 or potential discontinuance of the drug as required by s. 506C 146 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c. 147 2. Reclassify a drug to a more restrictive drug tier or 148 increase the amount that an insured must pay for a copayment, 149 coinsurance, or deductible for prescription drug benefits, or 150 reclassify a drug to a higher cost-sharing tier during the 151 contract year. 152 (b) This subsection does not: 153 1. Prohibit the addition of prescription drugs to the list 154 of drugs covered during the contract year. 155 2. Apply to a grandfathered health plan as defined in s. 156 627.402 or to benefits set forth in s. 627.6513(1)-(14). 157 3. Alter or amend s. 465.025, which provides conditions 158 under which a pharmacist may substitute a generically equivalent 159 drug product for a brand name drug product. 160 4. Alter or amend s. 465.0252, which provides conditions 161 under which a pharmacist may dispense a substitute biological 162 product for the prescribed biological product. 163 Section 4. The Legislature finds that this act fulfills an 164 important state interest. 165 Section 5. This act shall take effect January 1, 2018.