Florida Senate - 2022                                    SB 1290
       By Senator Gruters
       23-00781B-22                                          20221290__
    1                        A bill to be entitled                      
    2         An act relating to patient-specific drug coverage
    3         transparency; creating s. 456.45, F.S.; providing
    4         legislative intent; defining terms; authorizing
    5         patients to request, and requiring ordering or
    6         prescribing health care providers to provide, real
    7         time, patient-specific information regarding
    8         prescription drug benefits, coverage, and costs for a
    9         specified purpose; authorizing health care providers
   10         to provide such information to patients regardless of
   11         whether a request is made; authorizing patients to
   12         refuse such information; requiring insurers to provide
   13         specified information to health care providers;
   14         specifying requirements for the provision of such
   15         information; authorizing insurers to enter into
   16         agreements with third parties designated by health
   17         care providers to facilitate the exchange of such
   18         information; providing limitations on such agreements;
   19         providing an effective date.
   21  Be It Enacted by the Legislature of the State of Florida:
   23         Section 1. Section 456.45, Florida Statutes, is created to
   24  read:
   25         456.45 Informed prescribing decisions; patient-specific
   26  prescription drug coverage transparency.—
   27         (1)It is the intent of the Legislature to enable health
   28  care providers to make fully informed prescribing decisions,
   29  increase patient adherence to medication, and promote
   30  transparency of health care and prescription drug costs to the
   31  patient by facilitating real-time conversations between patients
   32  and health care providers about patient-specific information
   33  regarding prescription drug benefits, coverage, and costs.
   34         (2)As used in this section, the term:
   35         (a)“Health care provider” means a health care practitioner
   36  authorized by law to prescribe or order prescription drugs.
   37         (b)“Insurer” means a health insurer licensed under chapter
   38  627 or a health maintenance organization licensed under chapter
   39  641 or any entity acting on behalf of a health insurer or health
   40  maintenance organization.
   41         (c)“Patient-specific information regarding prescription
   42  drug benefits, coverage, and costs” means, but is not limited
   43  to, applicable drug formulary and benefit data, coverage for the
   44  prescribed or ordered prescription drug and clinically
   45  appropriate alternatives, and other applicable eligibility,
   46  benefit, and cost-sharing information specific to the patient.
   47         (d)“Point of care” means the time at which a health care
   48  provider, or his or her agent, prescribes or orders any
   49  prescription drug.
   50         (e)“Prescribing decision” means a health care provider’s,
   51  or his or her agent’s, decision to prescribe or order any
   52  prescription drug.
   53         (3)At the point of care, a patient may request, and the
   54  prescribing or ordering health care provider must provide upon
   55  such request, the patient’s real-time, patient-specific
   56  information regarding prescription drug benefits, coverage, and
   57  costs in order to facilitate a discussion of benefit, coverage,
   58  and cost options and to enable the health care provider to make
   59  a fully informed prescribing decision. A health care provider
   60  may offer this information regardless of whether the patient
   61  requests it, but the patient has the right to refuse the
   62  information.
   63         (4)To facilitate the exchange of information between
   64  patients and health care providers under this section, insurers
   65  shall provide to health care providers, at a minimum, all of the
   66  following information:
   67         (a)Patient-specific prescription drug benefits, including,
   68  but not limited to, any applicable drug formulary and benefit
   69  data, coverage for the prescribed drug, and clinically
   70  appropriate alternatives.
   71         (b)Patient-specific cost-sharing information. The
   72  information must include any variances in patient cost-sharing
   73  obligations based on which pharmacy dispenses the prescribed
   74  drug or its alternatives and the patient’s benefits and
   75  limitations, such as out-of-pocket maximums, deductibles, and
   76  other similar measures.
   77         (c)Any applicable utilization management requirements,
   78  such as prior authorization requirements.
   79         (5)Insurers shall make the information required under this
   80  section available to the requesting health care provider, or a
   81  third party designated by the health care provider, through a
   82  standard electronic data exchange or an application programming
   83  interface that uses standards accredited by the American
   84  National Standards Institute. The interface must be used solely
   85  for the purpose of integrating information required by this
   86  section into a health care provider’s workflow or electronic
   87  health recordkeeping system. An insurer may enter into an
   88  agreement with a third party designated by a health care
   89  provider to define the scope of, and access to, such
   90  information. However, the agreement may not prohibit the third
   91  party from displaying patient-specific information regarding
   92  prescription drug benefits, coverage, and costs which reflects
   93  other options, such as the out-of-pocket price, any patient
   94  assistance and support programs, and the cost available at the
   95  patient’s pharmacy of choice.
   96         Section 2. This act shall take effect January 1, 2023.