Florida Senate - 2022                          SENATOR AMENDMENT
       Bill No. HB 459
       
       
       
       
       
       
                                Ì3177520Î317752                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                  Floor: WD            .                                
             03/08/2022 11:56 AM       .                                
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       Senator Farmer moved the following:
       
    1         Senate Amendment 
    2  
    3         Delete lines 58 - 128
    4  and insert:
    5         (a)The prescription drug is a non-opioid based analgesic
    6  drug product, and the insurer’s step-therapy protocol would
    7  otherwise require the insured to be prescribed an opioid
    8  analgesic drug product or an abuse-deterrent opioid analgesic
    9  drug product; or
   10         (b)1.(a) The insured has previously been approved to
   11  receive the prescription drug through the completion of a step
   12  therapy protocol required by a separate health coverage plan;
   13  and
   14         2.(b) The insured provides documentation originating from
   15  the health coverage plan that approved the prescription drug as
   16  described in subparagraph 1. paragraph (a) indicating that the
   17  health coverage plan paid for the drug on the insured’s behalf
   18  during the 90 days immediately before the request.
   19         (3)(a)A health insurer shall publish on its website and
   20  provide to an insured in writing a procedure for the insured and
   21  his or her health care provider to request a protocol exemption
   22  or an appeal of the health insurer’s denial of a protocol
   23  exemption request. The procedure must include, at a minimum:
   24         1.The manner in which the insured or health care provider
   25  may request a protocol exemption, including a form to request
   26  the protocol exemption.
   27         2.The manner and timeframe in which the health insurer
   28  authorizes or denies a protocol exemption request, which must
   29  occur within a reasonable time.
   30         3.The manner and timeframe in which the insured or health
   31  care provider may appeal the health insurer’s denial of a
   32  protocol exemption request.
   33         (b)An authorization of a protocol exemption request must
   34  specify the approved prescription drug, medical procedure, or
   35  course of treatment. A denial of a protocol exemption request
   36  must include a written explanation of the reason for the denial,
   37  the clinical rationale that supports the denial, and the
   38  procedure for appealing the health insurer’s denial.
   39         (c)A health insurer may request relevant medical records
   40  in support of a protocol exemption request.
   41         (4)(3) This section does not require a health insurer to
   42  add a drug to its prescription drug formulary or to cover a
   43  prescription drug that the insurer does not otherwise cover.
   44         Section 2. Subsection (46) of section 641.31, Florida
   45  Statutes, is amended to read:
   46         641.31 Health maintenance contracts.—
   47         (46)(a)(46)(b) As used in this subsection, the term:
   48         1. “Health coverage plan” means any of the following which
   49  previously provided or is currently providing major medical or
   50  similar comprehensive coverage or benefits to the subscriber:
   51         a.1. A health insurer or health maintenance organization.;
   52         b.2. A plan established or maintained by an individual
   53  employer as provided by the Employee Retirement Income Security
   54  Act of 1974, Pub. L. No. 93-406.;
   55         c.3. A multiple-employer welfare arrangement as defined in
   56  s. 624.437.; or
   57         d.4. A governmental entity providing a plan of self
   58  insurance.
   59         2.“Protocol exemption” means a determination by a health
   60  maintenance organization to authorize the use of another
   61  prescription drug, medical procedure, or course of treatment
   62  prescribed or recommended by the treating health care provider
   63  for the subscriber’s condition rather than the one specified by
   64  the health maintenance organization’s step-therapy protocol.
   65         3.“Step-therapy protocol” means a written protocol that
   66  specifies the order in which certain prescription drugs, medical
   67  procedures, or courses of treatment must be used to treat a
   68  subscriber’s condition.
   69         (b)(a)In addition to the protocol exemptions granted under
   70  paragraph (c), a health maintenance organization issuing major
   71  medical coverage through an individual or group contract may not
   72  require a step-therapy protocol under the contract for a covered
   73  prescription drug requested by a subscriber if:
   74         1.The prescription drug is a non-opioid based analgesic
   75  drug product, and the health maintenance organization’s step
   76  therapy protocol would otherwise require the subscriber to be
   77  prescribed an opioid analgesic drug product or an abuse
   78  deterrent opioid analgesic drug product; or
   79         2.a.1. The subscriber has previously been approved to
   80  receive the prescription drug through the completion of a step
   81  therapy protocol required by a separate health coverage plan;
   82  and
   83         b.2. The subscriber provides documentation originating from
   84  the health coverage plan that approved the prescription drug as
   85  described in sub-subparagraph a. subparagraph 1. indicating that
   86  the health coverage plan paid for the drug on the subscriber’s
   87  behalf during the 90 days immediately before the request.