Florida Senate - 2018                        COMMITTEE AMENDMENT
       Bill No. CS for CS for SB 1494
       
       
       
       
       
       
                                Ì722650~Î722650                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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       The Committee on Appropriations (Montford) recommended the
       following:
       
    1         Senate Amendment 
    2  
    3         Delete lines 116 - 192
    4  and insert:
    5         (5) This section applies to contracts entered into,
    6  modified, amended, altered, or renewed on or after July 1, 2018.
    7         Section 5. Section 627.6572, Florida Statutes, is created
    8  to read:
    9         627.6572 Pharmacy benefit manager contracts.—
   10         (1) As used in this section, the term:
   11         (a) “Maximum allowable cost” means the per-unit amount that
   12  a pharmacy benefit manager reimburses a pharmacist for a
   13  prescription drug, excluding dispensing fees, prior to the
   14  application of copayments, coinsurance, and any other cost
   15  sharing charges.
   16         (b) “Pharmacy benefit 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 insurer
   19  to residents of this state.
   20         (2) A contract between a health insurer and a pharmacy
   21  benefit manager must require that the pharmacy benefit manager:
   22         (a) Update maximum allowable cost pricing information at
   23  least every 7 calendar days.
   24         (b) Maintain a process that will, in a timely manner,
   25  eliminate drugs from maximum allowable cost lists or modify drug
   26  prices to remain consistent with changes in pricing data used in
   27  formulating maximum allowable cost prices and product
   28  availability.
   29         (3) A contract between a health insurer and a pharmacy
   30  benefit manager must prohibit the pharmacy benefit manager from
   31  limiting a pharmacist’s ability to disclose whether the cost
   32  sharing obligation exceeds the retail price for a covered
   33  prescription drug, and the availability of a more affordable
   34  alternative drug, pursuant to s. 465.0244.
   35         (4) A contract between a health insurer and a pharmacy
   36  benefit manager must prohibit the pharmacy benefit manager from
   37  requiring an insured to make a payment for a prescription drug
   38  at the point of sale in an amount that exceeds the lesser of:
   39         (a) The applicable cost-sharing amount; or
   40         (b) The retail price of the drug in the absence of
   41  prescription drug coverage.
   42         (5) This section applies to contracts entered into,
   43  modified, amended, altered, or renewed on or after July 1, 2018.
   44         Section 6. Section 641.314, Florida Statutes, is created to
   45  read:
   46         641.314 Pharmacy benefit manager contracts.—
   47         (1) As used in this section, the term:
   48         (a) “Maximum allowable cost” means the per-unit amount that
   49  a pharmacy benefit manager reimburses a pharmacist for a
   50  prescription drug, excluding dispensing fees, prior to the
   51  application of copayments, coinsurance, and any other cost
   52  sharing charges.
   53         (b) “Pharmacy benefit manager” means a person or entity
   54  doing business in this state which contracts to administer or
   55  manage prescription drug benefits on behalf of a health
   56  maintenance organization to residents of this state.
   57         (2) A contract between a health maintenance organization
   58  and a pharmacy benefit manager must require that the pharmacy
   59  benefit manager:
   60         (a) Update maximum allowable cost pricing information at
   61  least every 7 calendar days.
   62         (b) Maintain a process that will, in a timely manner,
   63  eliminate drugs from maximum allowable cost lists or modify drug
   64  prices to remain consistent with changes in pricing data used in
   65  formulating maximum allowable cost prices and product
   66  availability.
   67         (3) A contract between a health maintenance organization
   68  and a pharmacy benefit manager must prohibit the pharmacy
   69  benefit manager from limiting a pharmacist’s ability to disclose
   70  whether the cost-sharing obligation exceeds the retail price for
   71  a covered prescription drug, and the availability of a more
   72  affordable alternative drug, pursuant to s. 465.0244.
   73         (4) A contract between a health maintenance organization
   74  and a pharmacy benefit manager must prohibit the pharmacy
   75  benefit manager from requiring a subscriber to make a payment
   76  for a prescription drug at the point of sale in an amount that
   77  exceeds the lesser of:
   78         (a) The applicable cost-sharing amount; or
   79         (b) The retail price of the drug in the absence of
   80  prescription drug coverage.
   81         (5) This section applies to contracts entered into,
   82  modified, amended, altered, or