Florida Senate - 2009                                     SB 558
       
       
       
       By Senator Fasano
       
       
       
       
       11-00386-09                                            2009558__
    1                        A bill to be entitled                      
    2         An act relating to insurance coverage for prescription
    3         drugs; prohibiting health insurance policies or
    4         contracts for a health care service plan from
    5         limiting, reducing, or denying coverage for a
    6         prescription drug under certain circumstances;
    7         providing that the act does not prohibit an insurer
    8         from making uniform changes in its benefit design or
    9         increasing cost-sharing obligations for a prescription
   10         drug due to an increase in price; providing an
   11         effective date.
   12         
   13  Be It Enacted by the Legislature of the State of Florida:
   14         
   15         Section 1. (1) A health insurance policy or a contract for
   16  a health care service plan that covers prescription drugs may
   17  not limit, reduce, or deny coverage to a particular insured
   18  individual for a drug if, prior to the limitation, reduction, or
   19  denial of coverage:
   20         (a) The insured was using the drug;
   21         (b) The insured was covered under the policy or contract;
   22  and
   23         (c) The drug was covered under the policy or contract.
   24         (2) A limitation, reduction, or denial of coverage includes
   25  removing a drug from the formulary or other drug list, imposing
   26  new management tools regarding prior authorization or the use of
   27  the drug, placing the drug on a formulary tier that increases
   28  the patient's cost-sharing obligations, or otherwise increasing
   29  the patient's cost-sharing obligations for obtaining the drug.
   30  This section does not prohibit an insurer from making uniform
   31  changes in its benefit design which apply to all covered drugs
   32  or from increasing cost-sharing obligations for a drug merely
   33  due to a percentage coinsurance payment that necessarily
   34  increases with an increase in the underlying drug price.
   35         Section 2. This act shall take effect July 1, 2009.