The Florida Senate

110.12315  Prescription drug program.--

(1)  Under the state employees' prescription drug program, copayments must be made as follows:

(a)  Fifteen-dollar copayment for brand name drug with card;

(b)  Five-dollar copayment for generic drug with card;

(c)  Five-dollar copayment for generic mail order drug;

(d)  Fifteen-dollar copayment for brand name mail order drug.

There shall be a 30-day supply limit for prescription card purchases; there shall be a 90-day supply limit for mail order or mail order prescription drug purchases.

(2)

(a)  Notwithstanding provisions of statute or agency administrative rules that may have been enacted or adopted prior to April 8, 1992, the ¹Division of State Group Insurance, in making provision for reimbursement for prescription medicines dispensed to members of the State Group Health Insurance Plan and their dependents, shall allow prescriptions written by health care providers under the plan to be filled by any licensed pharmacy pursuant to contractual claims-processing provisions. Retail pharmacies participating in this program shall be reimbursed at a uniform rate and subject to uniform conditions, according to the terms and conditions of the plan established by the ¹Division of State Group Insurance and relevant provisions of the annual General Appropriations Act and implementing legislation. Nothing in this section shall be construed as prohibiting a mail order prescription drug program distinct from the service provided by retail pharmacies.

(b)  The reimbursement schedule developed by the ¹Division of State Group Insurance for a prescription pharmaceutical shall be based on the cost of the generic equivalent drug if a generic equivalent exists, unless the physician prescribing the pharmaceutical clearly states on the prescription that the brand name drug is medically necessary or that the drug product is included on the formulary of drug products that may not be interchanged as provided in chapter 465. In cases in which the physician indicates that a brand name drug is medically necessary, reimbursement shall be based on the cost of the brand name drug as specified in the reimbursement plan adopted by the ¹Division of State Group Insurance.

(c)  Not later than October 1, 1992, the Department of Management Services shall implement a prescription utilization review program. All pharmacies dispensing medicines to members of the State Group Health Insurance Plan and their dependents shall be required to make records available for this review as a condition of participation in the State Group Health Insurance Plan.

(d)  The ¹Division of State Group Insurance shall assure the prompt implementation of this section and may reject all existing contract bids, rebid a pharmaceutical contract, or amend any existing pharmaceutical contract, and exercise any option for terminating any contract that conflicts with these provisions. The ¹Division of State Group Insurance shall incorporate additional cost savings and adjustments required to balance within appropriations provided, including, but not limited to, a trial or starter dose program and dispensing of long-term maintenance medication in lieu of acute therapy medication. This section does not authorize a reduction in the existing benefit configuration or allow premiums, deductions, or copayments to be raised above the levels specified in the 1992-1993 General Appropriations Act.

(3)  The current pharmacy dispensing fee shall remain in effect. Additionally, participating pharmacies are required to use a point-of-sale device or an on-line computer system to verify a participant's coverage. The state is not responsible or liable for payment for the prescription of a person whose eligibility has not been verified by the state's contracted administrator or the ¹Division of State Group Insurance.

History.--s. 53, ch. 92-69; s. 32, ch. 96-399; s. 4, ch. 97-92.

¹Note.--Section 4, ch. 97-296, requires the Division of Statutory Revision to prepare a reviser's bill for submission to the 1998 Regular Session of the Legislature substituting references to the Department of Management Services in the Florida Statutes for references to divisions, bureaus, or other units of that department. The Division of State Employees' Insurance was redesignated as the Division of State Group Insurance by s. 1, ch. 97-92.