Florida Senate - 2017                                     SB 800
       
       
        
       By Senator Broxson
       
       1-01138A-17                                            2017800__
    1                        A bill to be entitled                      
    2         An act relating to medication synchronization;
    3         creating s. 627.64196, F.S., and amending s. 641.31,
    4         F.S.; prohibiting, under certain circumstances,
    5         certain health insurance policies and health
    6         maintenance contracts, respectively, from denying
    7         coverage for partial supplies of medication dispensed
    8         by network pharmacies; requiring such policies and
    9         contracts to authorize and apply a prorated daily
   10         cost-sharing rate to certain prescriptions under
   11         certain circumstances; requiring such policies and
   12         contracts to allow network pharmacies to override
   13         denial codes under certain circumstances; prohibiting
   14         such policies and contracts from using payment
   15         structures incorporating prorated dispensing fees;
   16         providing requirements for dispensing fees for
   17         partially filled or refilled prescriptions; providing
   18         an effective date.
   19          
   20  Be It Enacted by the Legislature of the State of Florida:
   21  
   22         Section 1. Section 627.64196, Florida Statutes, is created
   23  to read:
   24         627.64196 Requirements for the partial fill or refill of
   25  prescriptions for medication synchronization purposes.—
   26         (1) An individual or group health insurance policy
   27  providing prescription drug coverage in this state may not deny
   28  coverage for a partial supply of medication dispensed by a
   29  network pharmacy and must authorize and apply a prorated daily
   30  cost-sharing rate to prescriptions that are dispensed by a
   31  network pharmacy for the partial supply if:
   32         (a) The prescribing practitioner or pharmacist determines
   33  the fill or refill to be in the best interest of the insured;
   34  and
   35         (b) The insured requests or agrees to a partial supply for
   36  the purpose of synchronizing his or her medications.
   37         (2) An individual or group health insurance policy:
   38         (a) Must allow, for the purposes of medication
   39  synchronization, a network pharmacy to override any denial code
   40  indicating that a prescription is being refilled too soon.
   41         (b) May not use payment structures incorporating prorated
   42  dispensing fees. Dispensing fees for partially filled or
   43  refilled prescriptions must be paid in full for each
   44  prescription dispensed, regardless of any prorated copay for the
   45  beneficiary or fee paid for alignment services.
   46         Section 2. Subsection (44) is added to section 641.31,
   47  Florida Statutes, to read:
   48         641.31 Health maintenance contracts.—
   49         (44)(a) A health maintenance contract providing
   50  prescription drug coverage in this state may not deny coverage
   51  for the dispensing of a partial supply of medication by a
   52  network pharmacy and must authorize and apply a prorated daily
   53  cost-sharing rate to prescriptions that are dispensed by a
   54  network pharmacy for the partial supply if:
   55         1. The prescribing practitioner or pharmacist determines
   56  the fill or refill to be in the best interest of the subscriber;
   57  and
   58         2. The subscriber requests or agrees to a partial supply
   59  for the purpose of synchronizing his or her medications.
   60         (b) A health maintenance contract:
   61         1. Must allow, for the purposes of medication
   62  synchronization, a network pharmacy to override any denial code
   63  indicating that a prescription is being refilled too soon.
   64         2. May not use payment structures incorporating prorated
   65  dispensing fees. Dispensing fees for partially filled or
   66  refilled prescriptions must be paid in full for each
   67  prescription dispensed, regardless of any prorated copay for the
   68  beneficiary or fee paid for alignment services.
   69         Section 3. This act shall take effect July 1, 2017.