Florida Senate - 2018                      CS for CS for SB 1494
       
       
        
       By the Committees on Banking and Insurance; and Health Policy;
       and Senators Montford, Grimsley, and Powell
       
       
       
       
       597-03453-18                                          20181494c2
    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 beginning on a
   13         specified date; providing requirements and terms of
   14         registration, including the payment of a nonrefundable
   15         fee; requiring the office to issue certificates of
   16         registration; specifying that certificates are
   17         nontransferable; requiring the Financial Services
   18         Commission to set an initial registration fee and a
   19         renewal fee which are nonrefundable and may not exceed
   20         a specified amount; requiring the commission to adopt
   21         rules; creating ss. 627.64741, 627.6572, and 641.314,
   22         F.S.; defining the terms “maximum allowable cost” and
   23         “pharmacy benefit manager”; requiring that certain
   24         terms be included in a contract between a health
   25         insurer or a health maintenance organization and a
   26         pharmacy benefit manager; providing applicability;
   27         providing an effective date.
   28          
   29  Be It Enacted by the Legislature of the State of Florida:
   30  
   31         Section 1. Section 465.0244, Florida Statutes, is amended
   32  to read:
   33         465.0244 Information disclosure.—
   34         (1) Every pharmacy shall make available on its website a
   35  hyperlink to the health information that is disseminated by the
   36  Agency for Health Care Administration pursuant to s. 408.05(3)
   37  and shall place in the area where customers receive filled
   38  prescriptions notice that such information is available
   39  electronically and the address of its Internet website.
   40         (2)In addition to the requirements of s. 465.025, a
   41  pharmacist or her or his authorized employee must inform a
   42  customer of a less expensive, generically equivalent drug
   43  product for her or his prescription and as to whether the
   44  customer’s cost-sharing obligation exceeds the retail price of
   45  the prescription in the absence of prescription drug coverage.
   46         Section 2. Section 465.1862, Florida Statutes, is repealed.
   47         Section 3. Section 624.490, Florida Statutes, is created to
   48  read:
   49         624.490Registration of pharmacy benefit managers.—
   50         (1)As used in this section, the term “pharmacy benefit
   51  manager” means a person or entity doing business in this state
   52  which contracts to administer prescription drug benefits on
   53  behalf of a health insurer or a health maintenance organization
   54  to residents of this state.
   55         (2) Beginning January 1, 2019, a pharmacy benefit manager
   56  must register with the office to conduct business in this state.
   57  To initially register or renew a registration, a pharmacy
   58  benefit manager must submit:
   59         (a)A nonrefundable fee;
   60         (b)A copy of the registrant’s corporate charter, articles
   61  of incorporation, or other charter document; and
   62         (c)A completed registration on a form adopted by the
   63  commission which contains:
   64         1.The name and address of the registrant; and
   65         2.The name, address, and official position of each officer
   66  and director of the registrant.
   67         (3)The registrant shall report any change in information
   68  required by subsection (2) to the office in writing within 60
   69  days after the change occurs.
   70         (4)Upon receipt of a completed registration form, required
   71  documents, and the registration fee, the office shall issue a
   72  registration certificate. The certificate may be in paper or
   73  electronic form, and must indicate the expiration date of the
   74  registration. Registration certificates are nontransferable.
   75         (5)A registration certificate is valid for 2 years from
   76  its date of issue. The commission shall adopt by rule an initial
   77  registration fee not to exceed $500 and a registration renewal
   78  fee not to exceed $500, both of which are nonrefundable.
   79         (6)The commission shall adopt rules necessary to implement
   80  this section.
   81         Section 4. Section 627.64741, Florida Statutes, is created
   82  to read:
   83         627.64741Pharmacy benefit manager contracts.—
   84         (1)As used in this section, the term:
   85         (a)“Maximum allowable cost” means the per-unit amount that
   86  a pharmacy benefit manager reimburses a pharmacist for a
   87  prescription drug, excluding dispensing fees, prior to the
   88  application of copayments, coinsurance, and other cost-sharing
   89  charges, if any.
   90         (b)“Pharmacy benefit manager” means a person or entity
   91  doing business in this state which contracts to administer or
   92  manage prescription drug benefits on behalf of a health insurer
   93  to residents of this state.
   94         (2)A contract between a health insurer and a pharmacy
   95  benefit manager must require that the pharmacy benefit manager:
   96         (a)Update maximum allowable cost pricing information at
   97  least every 7 calendar days.
   98         (b)Maintain a process that will, in a timely manner,
   99  eliminate drugs from maximum allowable cost lists or modify drug
  100  prices to remain consistent with changes in pricing data used in
  101  formulating maximum allowable cost prices and product
  102  availability.
  103         (3)A contract between a health insurer and a pharmacy
  104  benefit manager must prohibit the pharmacy benefit manager from
  105  limiting a pharmacist’s ability to disclose whether the cost
  106  sharing obligation exceeds the retail price for a covered
  107  prescription drug, and the availability of a more affordable
  108  alternative drug, pursuant to s. 465.0244.
  109         (4)A contract between a health insurer and a pharmacy
  110  benefit manager must prohibit the pharmacy benefit manager from
  111  requiring an insured to make a payment for a prescription drug
  112  at the point of sale in an amount that exceeds the lesser of:
  113         (a)The applicable cost-sharing amount; or
  114         (b)The retail price of the drug in the absence of
  115  prescription drug coverage.
  116         (5) This section applies to contracts entered into or
  117  renewed on or after July 1, 2018.
  118         Section 5. Section 627.6572, Florida Statutes, is created
  119  to read:
  120         627.6572Pharmacy benefit manager contracts.—
  121         (1)As used in this section, the term:
  122         (a)“Maximum allowable cost” means the per-unit amount that
  123  a pharmacy benefit manager reimburses a pharmacist for a
  124  prescription drug, excluding dispensing fees, prior to the
  125  application of copayments, coinsurance, and any other cost
  126  sharing charges.
  127         (b)“Pharmacy benefit manager” means a person or entity
  128  doing business in this state which contracts to administer or
  129  manage prescription drug benefits on behalf of a health insurer
  130  to residents of this state.
  131         (2)A contract between a health insurer and a pharmacy
  132  benefit manager must require that the pharmacy benefit manager:
  133         (a)Update maximum allowable cost pricing information at
  134  least every 7 calendar days.
  135         (b)Maintain a process that will, in a timely manner,
  136  eliminate drugs from maximum allowable cost lists or modify drug
  137  prices to remain consistent with changes in pricing data used in
  138  formulating maximum allowable cost prices and product
  139  availability.
  140         (3)A contract between a health insurer and a pharmacy
  141  benefit manager must prohibit the pharmacy benefit manager from
  142  limiting a pharmacist’s ability to disclose whether the cost
  143  sharing obligation exceeds the retail price for a covered
  144  prescription drug, and the availability of a more affordable
  145  alternative drug, pursuant to s. 465.0244.
  146         (4)A contract between a health insurer and a pharmacy
  147  benefit manager must prohibit the pharmacy benefit manager from
  148  requiring an insured to make a payment for a prescription drug
  149  at the point of sale in an amount that exceeds the lesser of:
  150         (a)The applicable cost-sharing amount; or
  151         (b)The retail price of the drug in the absence of
  152  prescription drug coverage.
  153         (5) This section applies to contracts entered into or
  154  renewed on or after July 1, 2018.
  155         Section 6. Section 641.314, Florida Statutes, is created to
  156  read:
  157         641.314Pharmacy benefit manager contracts.—
  158         (1)As used in this section, the term:
  159         (a)“Maximum allowable cost” means the per-unit amount that
  160  a pharmacy benefit manager reimburses a pharmacist for a
  161  prescription drug, excluding dispensing fees, prior to the
  162  application of copayments, coinsurance, and any other cost
  163  sharing charges.
  164         (b)“Pharmacy benefit manager” means a person or entity
  165  doing business in this state which contracts to administer or
  166  manage prescription drug benefits on behalf of a health
  167  maintenance organization to residents of this state.
  168         (2)A contract between a health maintenance organization
  169  and a pharmacy benefit manager must require that the pharmacy
  170  benefit manager:
  171         (a)Update maximum allowable cost pricing information at
  172  least every 7 calendar days.
  173         (b)Maintain a process that will, in a timely manner,
  174  eliminate drugs from maximum allowable cost lists or modify drug
  175  prices to remain consistent with changes in pricing data used in
  176  formulating maximum allowable cost prices and product
  177  availability.
  178         (3)A contract between a health maintenance organization
  179  and a pharmacy benefit manager must prohibit the pharmacy
  180  benefit manager from limiting a pharmacist’s ability to disclose
  181  whether the cost-sharing obligation exceeds the retail price for
  182  a covered prescription drug, and the availability of a more
  183  affordable alternative drug, pursuant to s. 465.0244.
  184         (4)A contract between a health maintenance organization
  185  and a pharmacy benefit manager must prohibit the pharmacy
  186  benefit manager from requiring a subscriber to make a payment
  187  for a prescription drug at the point of sale in an amount that
  188  exceeds the lesser of:
  189         (a)The applicable cost-sharing amount; or
  190         (b)The retail price of the drug in the absence of
  191  prescription drug coverage.
  192         (5) This section applies to contracts entered into or
  193  renewed on or after July 1, 2018.
  194         Section 7. This act shall take effect July 1, 2018.