Florida Senate - 2018 CS for SB 1494
By the Committee on Health Policy; and Senators Montford and
Grimsley
588-02927-18 20181494c1
1 A bill to be entitled
2 An act relating to prescription drug pricing
3 transparency; amending s. 465.0244, F.S.; requiring
4 pharmacists to inform customers of less expensive,
5 generically equivalent drugs for their prescriptions
6 and as to whether customers’ cost-sharing obligations
7 exceed the retail price of their prescriptions;
8 repealing s. 465.1862, F.S., relating to pharmacy
9 benefit manager contracts; creating s. 624.490, F.S.;
10 defining the term “pharmacy benefit manager”;
11 requiring a pharmacy benefit manager to register with
12 the Office of Insurance Regulation; providing
13 requirements and terms of registration, including the
14 payment of a registration fee; requiring the office to
15 issue certificates of registration and to set an
16 initial registration fee and a renewal fee, which may
17 not exceed a specified amount; requiring the office to
18 adopt rules; creating ss. 627.64741, 627.6572, and
19 641.314, F.S.; defining the terms “maximum allowable
20 cost” and “pharmacy benefit manager”; requiring that
21 certain terms be included in a contract between a
22 health insurer or a health maintenance organization
23 and a pharmacy benefit manager; providing
24 applicability; providing an effective date.
25
26 Be It Enacted by the Legislature of the State of Florida:
27
28 Section 1. Section 465.0244, Florida Statutes, is amended
29 to read:
30 465.0244 Information disclosure.—
31 (1) Every pharmacy shall make available on its website a
32 hyperlink to the health information that is disseminated by the
33 Agency for Health Care Administration pursuant to s. 408.05(3)
34 and shall place in the area where customers receive filled
35 prescriptions notice that such information is available
36 electronically and the address of its Internet website.
37 (2) In addition to the requirements of s. 465.025, a
38 pharmacist or her or his authorized employee must inform a
39 customer of a less expensive, generically equivalent drug
40 product for her or his prescription and as to whether the
41 customer’s cost-sharing obligation exceeds the retail price of
42 the prescription in the absence of prescription drug coverage.
43 Section 2. Section 465.1862, Florida Statutes, is repealed.
44 Section 3. Section 624.490, Florida Statutes, is created to
45 read:
46 624.490 Registration of pharmacy benefit managers.—
47 (1) As used in this section, the term “pharmacy benefit
48 manager” means a person or entity doing business in this state
49 which contracts to administer prescription drug benefits on
50 behalf of a health insurer or a health maintenance organization
51 to residents of this state.
52 (2) To conduct business in this state, a pharmacy benefit
53 manager must register with the office. To register, a pharmacy
54 benefit manager shall submit:
55 (a) A fee determined by the office.
56 (b) A copy of the registrant’s corporate charter, articles
57 of incorporation, or other charter document.
58 (c) A form established by the office containing the
59 identity, address, and taxpayer identification number, when
60 applicable, of:
61 1. The registrant.
62 2. The chief executive officer or a similarly titled person
63 responsible for the executive oversight of the registrant.
64 3. The chief financial officer or a similarly titled person
65 responsible for the financial oversight of the registrant.
66 4. Each person or entity responsible for the affairs of the
67 registrant, including, but not limited to, the day-to-day
68 operations of the registrant.
69 (3) The registrant shall report any change in information
70 required by subsection (2) to the office in writing within 60
71 days after the change occurs.
72 (4) Upon receipt of a completed registration form and the
73 registration fee, the office shall issue a registration
74 certificate. The certificate may be in paper or electronic form,
75 and shall clearly indicate the expiration date of the
76 registration. Registration certificates are nontransferable.
77 (5) A registration certificate is valid for 2 years from
78 its date of issue. The office shall set an initial registration
79 fee and a registration renewal fee, both of which shall be
80 nonrefundable. Total fees may not exceed the cost of
81 administering this section or $500, whichever is less.
82 (6) The office shall adopt rules necessary to implement
83 this section.
84 Section 4. Section 627.64741, Florida Statutes, is created
85 to read:
86 627.64741 Pharmacy benefit manager contracts.—
87 (1) As used in this section, the term:
88 (a) “Maximum allowable cost” means the per-unit amount that
89 a pharmacy benefit manager reimburses a pharmacist for a
90 prescription drug, excluding dispensing fees, prior to the
91 application of copayments, coinsurance, and other cost-sharing
92 charges, if any.
93 (b) “Pharmacy benefit manager” means a person or entity
94 doing business in this state which contracts to administer or
95 manage prescription drug benefits on behalf of a health insurer
96 to residents of this state.
97 (2) A contract between a health insurer and a pharmacy
98 benefit manager must require that the pharmacy benefit manager:
99 (a) Update maximum allowable cost pricing information at
100 least every 7 calendar days.
101 (b) Maintain a process that will, in a timely manner,
102 eliminate drugs from maximum allowable cost lists or modify drug
103 prices to remain consistent with changes in pricing data used in
104 formulating maximum allowable cost prices and product
105 availability.
106 (3) A contract between a health insurer and a pharmacy
107 benefit manager must prohibit the pharmacy benefit manager from
108 limiting a pharmacist’s ability to disclose whether the cost
109 sharing obligation exceeds the retail price for a covered
110 prescription drug, and the availability of a more affordable
111 alternative drug, pursuant to s. 465.0244.
112 (4) A contract between a health insurer and a pharmacy
113 benefit manager must prohibit the pharmacy benefit manager from
114 requiring an insured to make a payment for a prescription drug
115 at the point of sale in an amount that exceeds the lesser of:
116 (a) The applicable cost-sharing amount; or
117 (b) The retail price of the drug in the absence of
118 prescription drug coverage.
119 (5) This section applies to contracts entered into or
120 renewed on or after July 1, 2018.
121 Section 5. Section 627.6572, Florida Statutes, is created
122 to read:
123 627.6572 Pharmacy benefit manager contracts.—
124 (1) As used in this section, the term:
125 (a) “Maximum allowable cost” means the per-unit amount that
126 a pharmacy benefit manager reimburses a pharmacist for a
127 prescription drug, excluding dispensing fees, prior to the
128 application of copayments, coinsurance, and any other cost
129 sharing charges.
130 (b) “Pharmacy benefit manager” means a person or entity
131 doing business in this state which contracts to administer or
132 manage prescription drug benefits on behalf of a health insurer
133 to residents of this state.
134 (2) A contract between a health insurer and a pharmacy
135 benefit manager must require that the pharmacy benefit manager:
136 (a) Update maximum allowable cost pricing information at
137 least every 7 calendar days.
138 (b) Maintain a process that will, in a timely manner,
139 eliminate drugs from maximum allowable cost lists or modify drug
140 prices to remain consistent with changes in pricing data used in
141 formulating maximum allowable cost prices and product
142 availability.
143 (3) A contract between a health insurer and a pharmacy
144 benefit manager must prohibit the pharmacy benefit manager from
145 limiting a pharmacist’s ability to disclose whether the cost
146 sharing obligation exceeds the retail price for a covered
147 prescription drug, and the availability of a more affordable
148 alternative drug, pursuant to s. 465.0244.
149 (4) A contract between a health insurer and a pharmacy
150 benefit manager must prohibit the pharmacy benefit manager from
151 requiring an insured to make a payment for a prescription drug
152 at the point of sale in an amount that exceeds the lesser of:
153 (a) The applicable cost-sharing amount; or
154 (b) The retail price of the drug in the absence of
155 prescription drug coverage.
156 (5) This section applies to contracts entered into or
157 renewed on or after July 1, 2018.
158 Section 6. Section 641.314, Florida Statutes, is created to
159 read:
160 641.314 Pharmacy benefit manager contracts.—
161 (1) As used in this section, the term:
162 (a) “Maximum allowable cost” means the per-unit amount that
163 a pharmacy benefit manager reimburses a pharmacist for a
164 prescription drug, excluding dispensing fees, prior to the
165 application of copayments, coinsurance, and any other cost
166 sharing charges.
167 (b) “Pharmacy benefit manager” means a person or entity
168 doing business in this state which contracts to administer or
169 manage prescription drug benefits on behalf of a health
170 maintenance organization to residents of this state.
171 (2) A contract between a health maintenance organization
172 and a pharmacy benefit manager must require that the pharmacy
173 benefit manager:
174 (a) Update maximum allowable cost pricing information at
175 least every 7 calendar days.
176 (b) Maintain a process that will, in a timely manner,
177 eliminate drugs from maximum allowable cost lists or modify drug
178 prices to remain consistent with changes in pricing data used in
179 formulating maximum allowable cost prices and product
180 availability.
181 (3) A contract between a health maintenance organization
182 and a pharmacy benefit manager must prohibit the pharmacy
183 benefit manager from limiting a pharmacist’s ability to disclose
184 whether the cost-sharing obligation exceeds the retail price for
185 a covered prescription drug, and the availability of a more
186 affordable alternative drug, pursuant to s. 465.0244.
187 (4) A contract between a health maintenance organization
188 and a pharmacy benefit manager must prohibit the pharmacy
189 benefit manager from requiring a subscriber to make a payment
190 for a prescription drug at the point of sale in an amount that
191 exceeds the lesser of:
192 (a) The applicable cost-sharing amount; or
193 (b) The retail price of the drug in the absence of
194 prescription drug coverage.
195 (5) This section applies to contracts entered into or
196 renewed on or after July 1, 2018.
197 Section 7. This act shall take effect July 1, 2018.