Florida Senate - 2025 SB 1124
By Senator Simon
3-01313B-25 20251124__
1 A bill to be entitled
2 An act relating to pharmacist selection and
3 reimbursement; creating ss. 110.12305, 409.91193,
4 409.9773, 627.64743, 627.65723, and 641.3143, F.S.;
5 authorizing health plan members and covered
6 individuals under the state group insurance program
7 plans and health maintenance organizations, Medicaid
8 recipients under the Medicaid managed care plans and
9 Medicaid providers, Medicaid managed care enrollees
10 under eligible plans contracted with the Agency for
11 Health Care Administration for the Medicaid program,
12 insureds and covered individuals under individual
13 health insurance policies, insureds and covered
14 individuals under group, blanket, and franchise health
15 insurance policies, and subscribers and covered
16 individuals under health maintenance contracts,
17 respectively, to select in-network pharmacists for
18 services under certain circumstances; prohibiting
19 reimbursement to in-network pharmacists from being
20 denied under specified circumstances; providing that
21 licensed pharmacists may count toward network adequacy
22 standards for access to services within the scope of
23 practice of pharmacists; providing construction;
24 providing an effective date.
25
26 Be It Enacted by the Legislature of the State of Florida:
27
28 Section 1. Section 110.12305, Florida Statutes, is created
29 to read:
30 110.12305 Pharmacist selection and reimbursement.—
31 (1)(a) A health plan member or covered individual may
32 select an in-network pharmacist for any service covered by the
33 state group health insurance plan, state-contracted HMO, or any
34 other insurance plan under the state group insurance program
35 which is within the scope of practice of a pharmacist licensed
36 under chapter 465.
37 (b) Reimbursement to an in-network pharmacist may not be
38 denied for the provision of a service that is within the scope
39 of practice of a pharmacist licensed under chapter 465 if the
40 service, when provided by an allopathic physician licensed under
41 chapter 458, an osteopathic physician licensed under chapter
42 459, a physician assistant licensed under chapter 458 or chapter
43 459, or an advanced practice registered nurse licensed under
44 chapter 464, is covered by the state group health insurance
45 plan, health maintenance contract, or any other insurance plan
46 under the state group insurance program.
47 (2)(a) Pharmacists licensed under chapter 465 may count
48 toward network adequacy standards for provider access to
49 services provided within the scope of practice of pharmacists.
50 (b) The participation of pharmacies in the network’s drug
51 benefits does not satisfy the requirement of paragraph (a).
52 Section 2. Section 409.91193, Florida Statutes, is created
53 to read:
54 409.91193 Pharmacist selection and reimbursement.—
55 (1)(a) A Medicaid recipient may select an in-network
56 pharmacist for any service covered by the managed care plan or
57 Medicaid provider which is within the scope of practice of a
58 pharmacist licensed under chapter 465.
59 (b) Reimbursement to an in-network pharmacist may not be
60 denied for the provision of a service that is within the scope
61 of practice of a pharmacist licensed under chapter 465 if the
62 service, when provided by an allopathic physician licensed under
63 chapter 458, an osteopathic physician licensed under chapter
64 459, a physician assistant licensed under chapter 458 or chapter
65 459, or an advanced practice registered nurse licensed under
66 chapter 464, is covered by the managed care plan or Medicaid
67 provider.
68 (2)(a) Pharmacists licensed under chapter 465 may count
69 toward network adequacy standards for provider access to
70 services provided within the scope of practice of pharmacists.
71 (b) The participation of pharmacies in the network’s drug
72 benefits does not satisfy the requirement of paragraph (a).
73 Section 3. Section 409.9773, Florida Statutes, is created
74 to read:
75 409.9773 Pharmacist selection and reimbursement.—
76 (1)(a) A Medicaid managed care enrollee may select an in
77 network pharmacist for any service covered by the managed care
78 plan which is within the scope of practice of a pharmacist
79 licensed under chapter 465.
80 (b) Reimbursement to an in-network pharmacist may not be
81 denied for the provision of a service that is within the scope
82 of practice of a pharmacist licensed under chapter 465 if the
83 service, when provided by an allopathic physician licensed under
84 chapter 458, an osteopathic physician licensed under chapter
85 459, a physician assistant licensed under chapter 458 or chapter
86 459, or an advanced practice registered nurse licensed under
87 chapter 464, is covered by the managed care plan.
88 (2)(a) Pharmacists licensed under chapter 465 may count
89 toward network adequacy standards for provider access to
90 services provided within the scope of practice of pharmacists.
91 (b) The participation of pharmacies in the network’s drug
92 benefits does not satisfy the requirement of paragraph (a).
93 Section 4. Section 627.64743, Florida Statutes, is created
94 to read:
95 627.64743 Pharmacist selection and reimbursement.—
96 (1)(a) An insured or covered individual may select an in
97 network pharmacist for any service covered by the health
98 insurance policy which is within the scope of practice of a
99 pharmacist licensed under chapter 465.
100 (b) Reimbursement to an in-network pharmacist may not be
101 denied for the provision of a service that is within the scope
102 of practice of a pharmacist licensed under chapter 465 if the
103 service, when provided by an allopathic physician licensed under
104 chapter 458, an osteopathic physician licensed under chapter
105 459, a physician assistant licensed under chapter 458 or chapter
106 459, or an advanced practice registered nurse licensed under
107 chapter 464, is covered by the health insurance policy.
108 (2)(a) Pharmacists licensed under chapter 465 may count
109 toward network adequacy standards for provider access to
110 services provided within the scope of practice of pharmacists.
111 (b) The participation of pharmacies in the network’s drug
112 benefits does not satisfy the requirement of paragraph (a).
113 Section 5. Section 627.65723, Florida Statutes, is created
114 to read:
115 627.65723 Pharmacist selection and reimbursement.—
116 (1)(a) An insured or covered individual may select an in
117 network pharmacist for any service covered by the health
118 insurance policy which is within the scope of practice of a
119 pharmacist licensed under chapter 465.
120 (b) Reimbursement to an in-network pharmacist may not be
121 denied for the provision of a service that is within the scope
122 of practice of a pharmacist licensed under chapter 465 if the
123 service, when provided by an allopathic physician licensed under
124 chapter 458, an osteopathic physician licensed under chapter
125 459, a physician assistant licensed under chapter 458 or chapter
126 459, or an advanced practice registered nurse licensed under
127 chapter 464, is covered by the health insurance policy.
128 (2)(a) Pharmacists licensed under chapter 465 may count
129 toward network adequacy standards for provider access to
130 services provided within the scope of practice of pharmacists.
131 (b) The participation of pharmacies in the network’s drug
132 benefits does not satisfy the requirement of paragraph (a).
133 Section 6. Section 641.3143, Florida Statutes, is created
134 to read:
135 641.3143 Pharmacist selection and reimbursement.—
136 (1)(a) A subscriber or covered individual may select an in
137 network pharmacist for any service covered by the health
138 maintenance contract which is within the scope of practice of a
139 pharmacist licensed under chapter 465.
140 (b) Reimbursement to an in-network pharmacist may not be
141 denied for the provision of a service that is within the scope
142 of practice of a pharmacist licensed under chapter 465 if the
143 service, when provided by an allopathic physician licensed under
144 chapter 458, an osteopathic physician licensed under chapter
145 459, a physician assistant licensed under chapter 458 or chapter
146 459, or an advanced practice registered nurse licensed under
147 chapter 464, is covered by the health maintenance contract.
148 (2)(a) Pharmacists licensed under chapter 465 may count
149 toward network adequacy standards for provider access to
150 services provided within the scope of practice of pharmacists.
151 (b) The participation of pharmacies in the network’s drug
152 benefits does not satisfy the requirement of paragraph (a).
153 Section 7. This act shall take effect January 1, 2026.