Florida Senate - 2018                                     SB 534
       By Senator Grimsley
       26-00674-18                                            2018534__
    1                        A bill to be entitled                      
    2         An act relating to the regulation of pharmacy benefits
    3         managers; amending s. 465.1862, F.S.; deleting an
    4         obsolete cross-reference; defining the term “health
    5         insurance plan”; amending s. 626.88, F.S.; redefining
    6         the term “administrator” to include pharmacy benefits
    7         managers; making technical changes; providing an
    8         effective date.
   10  Be It Enacted by the Legislature of the State of Florida:
   12         Section 1. Paragraph (b) of subsection (1) of section
   13  465.1862, Florida Statutes, is amended to read:
   14         465.1862 Pharmacy benefits manager contracts.—
   15         (1) As used in this section, the term:
   16         (b) “Pharmacy benefits manager” means a person or entity
   17  doing business in this state which contracts to administer or
   18  manage prescription drug benefits on behalf of a health
   19  insurance plan, as defined in former s. 627.6482, to residents
   20  of this state. For purposes of this paragraph, the term “health
   21  insurance plan” means any hospital and medical expense incurred
   22  policy, minimum premium plan, stop-loss coverage, health
   23  maintenance organization contract, prepaid health clinic
   24  contract, multiple-employer welfare arrangement contract, or
   25  fraternal benefit society health benefits contract, whether sold
   26  as an individual or group policy or contract; but the term does
   27  not include any policy covering medical payments coverage or
   28  personal injury protection coverage in a motor vehicle policy,
   29  coverage issued as a supplement to liability insurance, or
   30  workers’ compensation.
   31         Section 2. Subsection (1) of section 626.88, Florida
   32  Statutes, is amended to read:
   33         626.88 Definitions.—For the purposes of this part, the
   34  term:
   35         (1) “Administrator” means is any person who directly or
   36  indirectly solicits or effects coverage of, collects charges or
   37  premiums from, or adjusts or settles claims on residents of this
   38  state in connection with authorized commercial self-insurance
   39  funds or with insured or self-insured programs which provide
   40  life or health insurance coverage or coverage of any other
   41  expenses described in s. 624.33(1); or any person who, through a
   42  health care risk contract as defined in s. 641.234 with an
   43  insurer or health maintenance organization, provides billing and
   44  collection services to health insurers and health maintenance
   45  organizations on behalf of health care providers; or a pharmacy
   46  benefits manager as defined in s. 465.1862(1). The term does not
   47  include, other than any of the following persons:
   48         (a) An employer or wholly owned direct or indirect
   49  subsidiary of an employer, on behalf of such employer’s
   50  employees or the employees of one or more subsidiary or
   51  affiliated corporations of such employer.
   52         (b) A union on behalf of its members.
   53         (c) An insurance company which is either authorized to
   54  transact insurance in this state or is acting as an insurer with
   55  respect to a policy lawfully issued and delivered by such
   56  company in and pursuant to the laws of a state in which the
   57  insurer was authorized to transact an insurance business.
   58         (d) A health care services plan, health maintenance
   59  organization, professional service plan corporation, or person
   60  in the business of providing continuing care, possessing a valid
   61  certificate of authority issued by the office, and the sales
   62  representatives thereof, if the activities of such entity are
   63  limited to the activities permitted under the certificate of
   64  authority.
   65         (e) An entity that is affiliated with an insurer and that
   66  only performs the contractual duties, between the administrator
   67  and the insurer, of an administrator for the direct and assumed
   68  insurance business of the affiliated insurer. The insurer is
   69  responsible for the acts of the administrator and is responsible
   70  for providing all of the administrator’s books and records to
   71  the insurance commissioner, upon a request from the insurance
   72  commissioner. For purposes of this paragraph, the term “insurer”
   73  means a licensed insurance company, health maintenance
   74  organization, prepaid limited health service organization, or
   75  prepaid health clinic.
   76         (f) A nonresident entity licensed in its state of domicile
   77  as an administrator if its duties in this state are limited to
   78  the administration of a group policy or plan of insurance and no
   79  more than a total of 100 lives for all plans reside in this
   80  state.
   81         (g) An insurance agent licensed in this state whose
   82  activities are limited exclusively to the sale of insurance.
   83         (h) A person licensed as a managing general agent in this
   84  state, whose activities are limited exclusively to the scope of
   85  activities conveyed under such license.
   86         (i) An adjuster licensed in this state whose activities are
   87  limited to the adjustment of claims.
   88         (j) A creditor on behalf of such creditor’s debtors with
   89  respect to insurance covering a debt between the creditor and
   90  its debtors.
   91         (k) A trust and its trustees, agents, and employees acting
   92  pursuant to such trust established in conformity with 29 U.S.C.
   93  s. 186.
   94         (l) A trust exempt from taxation under s. 501(a) of the
   95  Internal Revenue Code, a trust satisfying the requirements of
   96  ss. 624.438 and 624.439, or any governmental trust as defined in
   97  s. 624.33(3), and the trustees and employees acting pursuant to
   98  such trust, or a custodian and its agents and employees,
   99  including individuals representing the trustees in overseeing
  100  the activities of a service company or administrator, acting
  101  pursuant to a custodial account which meets the requirements of
  102  s. 401(f) of the Internal Revenue Code.
  103         (m) A financial institution which is subject to supervision
  104  or examination by federal or state authorities or a mortgage
  105  lender licensed under chapter 494 who collects and remits
  106  premiums to licensed insurance agents or authorized insurers
  107  concurrently or in connection with mortgage loan payments.
  108         (n) A credit card issuing company which advances for and
  109  collects premiums or charges from its credit card holders who
  110  have authorized such collection if such company does not adjust
  111  or settle claims.
  112         (o) A person who adjusts or settles claims in the normal
  113  course of such person’s practice or employment as an attorney at
  114  law and who does not collect charges or premiums in connection
  115  with life or health insurance coverage.
  116         (p) A person approved by the department who administers
  117  only self-insured workers’ compensation plans.
  118         (q) A service company or service agent and its employees,
  119  authorized in accordance with ss. 626.895-626.899, serving only
  120  a single employer plan, multiple-employer welfare arrangements,
  121  or a combination thereof.
  122         (r) Any provider or group practice, as defined in s.
  123  456.053, providing services under the scope of the license of
  124  the provider or the member of the group practice.
  125         (s) Any hospital providing billing, claims, and collection
  126  services solely on its own and its physicians’ behalf and
  127  providing services under the scope of its license.
  128         (t) A corporation not for profit whose membership consists
  129  entirely of local governmental units authorized to enter into
  130  risk management consortiums under s. 112.08.
  132  A person who provides billing and collection services to health
  133  insurers and health maintenance organizations on behalf of
  134  health care providers shall comply with the provisions of ss.
  135  627.6131, 641.3155, and 641.51(4).
  136         Section 3. This act shall take effect July 1, 2018.