Florida Senate - 2021 SB 1306 By Senator Rodriguez 39-01269-21 20211306__ 1 A bill to be entitled 2 An act relating to Medicaid pharmacy benefit savings; 3 creating s. 409.93, F.S.; providing a short title; 4 providing legislative findings; requiring the Agency 5 for Health Care Administration to select a single 6 pharmacy benefit administrator through a competitive 7 procurement process to administer all pharmacy 8 benefits for Medicaid recipients enrolled in managed 9 care plans; requiring the agency to complete the 10 procurement process and select the pharmacy benefit 11 administrator by a specified date; prohibiting managed 12 care organizations from providing pharmacy benefits 13 for their enrolled members; requiring the agency to 14 make certain considerations during the procurement 15 process; providing contract requirements; requiring 16 the agency to calculate an amount equal to a specified 17 percentage of each managed care organization’s net 18 underwriting gain for a certain contract year; 19 requiring the agency to reduce a managed care 20 organization’s contract term payment by such amount to 21 be used for specified purposes; providing an effective 22 date. 23 24 Be It Enacted by the Legislature of the State of Florida: 25 26 Section 1. Section 409.93, Florida Statutes, is created to 27 read: 28 409.93 Medicaid Pharmacy Benefit Savings Optimization Act.— 29 (1) This section may be cited as the “Medicaid Pharmacy 30 Benefit Savings Optimization Act.” 31 (2) The Legislature finds that: 32 (a) The Agency for Health Care Administration administers 33 Medicaid benefits for the state’s low-income beneficiaries and 34 aged and disabled persons as well as children’s health insurance 35 programs for uninsured children in low-income families. 36 (b) The agency provides certain Medicaid benefits to the 37 residents of this state directly through its fee-for-service 38 program or indirectly through managed care organizations. 39 (c) Pharmacy benefits for Medicaid patients in this state 40 are generally provided using managed care organizations. 41 (d) Despite efforts to reduce the costs of prescription 42 drugs, the state Medicaid program continues to experience 43 substantial increases in prescription drug costs each year. 44 (e) Several states have passed legislation removing 45 prescription drug benefits from their Medicaid managed care 46 delivery systems and providing all pharmacy benefits through 47 their existing fee-for-service programs or using a single 48 pharmacy benefit administrator, resulting in savings of hundreds 49 of millions of dollars for those states. 50 (f) Moving pharmacy benefits from the Medicaid managed care 51 delivery system and providing those benefits through a single 52 pharmacy benefit administrator using the state’s existing 53 Medicaid fee-for-service program could result in potentially 54 significant savings for the state. 55 (3)(a) The agency shall select a single pharmacy benefit 56 administrator through a competitive procurement process to 57 administer all pharmacy benefits for Medicaid recipients 58 enrolled in managed care plans. 59 (b) By October 1, 2021, the agency shall complete the 60 procurement process and select a single pharmacy benefit 61 administrator. Upon such selection, managed care organizations 62 may no longer provide pharmacy benefits for their enrolled 63 members. As part of the procurement process, the agency shall 64 consider pricing, quality, accessibility, and any potential 65 conflicts of interest the pharmacy benefit administrator may 66 have with the agency, a managed care plan, or a pharmacy 67 participating in the state’s Medicaid program. The contract with 68 the pharmacy benefit administrator must: 69 1. Establish the pharmacy benefit administrator’s fiduciary 70 duty to the state. 71 2. Require the use of pass-through pricing by the pharmacy 72 benefit administrator. 73 3. Require the pharmacy benefit administrator to use the 74 preferred drug list, reimbursement methodologies, and dispensing 75 fees established by the agency for its existing Medicaid fee 76 for-service program. 77 4. Prohibit the pharmacy benefit administrator from 78 requiring a Medicaid recipient to use a mail order pharmacy. 79 5. Prohibit the pharmacy benefit administrator from 80 excluding a pharmacy that is willing to accept reasonable terms 81 and conditions established by the pharmacy benefit administrator 82 to participate in the plan network. 83 (4) The agency shall calculate an amount equal to 20 84 percent of each managed care organization’s net underwriting 85 gain for the July 1, 2020, through June 30, 2021, contract year, 86 as determined by the agency’s Medicaid actuary. The agency shall 87 reduce each managed care organization’s subsequent contract term 88 payment by such amount and use this amount to provide pharmacy 89 benefits for managed care organization members, including any 90 costs incurred to implement this act. 91 Section 2. This act shall take effect upon becoming a law.