| 1 | A bill to be entitled |
| 2 | An act relating to insurance coverage for prescription |
| 3 | drugs; amending ss. 627.6045, 627.6561, and 641.31071, |
| 4 | F.S.; prohibiting health insurance policies or contracts |
| 5 | for a health care service plan from limiting, reducing, or |
| 6 | denying coverage for a prescription drug under certain |
| 7 | circumstances; providing that the insurer is not |
| 8 | prohibited from making uniform changes in its benefit |
| 9 | design or increasing cost-sharing obligations for a |
| 10 | prescription drug due to an increase in price; providing |
| 11 | that a change to any health insurance policy or contract |
| 12 | for a health care service plan is effective upon the |
| 13 | renewal of the policy or contract; requiring the insurer |
| 14 | to communicate the change and its effective date to the |
| 15 | insured; providing for nonapplicability to a managed care |
| 16 | plan under the Medicaid program; providing an effective |
| 17 | date. |
| 18 |
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| 19 | Be It Enacted by the Legislature of the State of Florida: |
| 20 |
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| 21 | Section 1. Subsections (5) and (6) are added to section |
| 22 | 627.6045, Florida Statutes, to read: |
| 23 | 627.6045 Preexisting condition.--A health insurance policy |
| 24 | must comply with the following: |
| 25 | (5) A health insurance policy or a contract for a health |
| 26 | care service plan that covers prescription drugs may not limit, |
| 27 | reduce, or deny coverage for a prescription drug to a particular |
| 28 | insured individual for the remainder of the current plan year |
| 29 | if, prior to the limitation, reduction, or denial of coverage: |
| 30 | (a) The insured was using the drug; |
| 31 | (b) The insured was covered under the policy or contract; |
| 32 | and |
| 33 | (c) The drug was covered under the policy or contract. |
| 34 | (6) A limitation, reduction, or denial of coverage |
| 35 | includes removing a drug from the formulary or other drug list, |
| 36 | imposing new management tools regarding prior authorization or |
| 37 | the use of the drug, placing the drug on a formulary tier that |
| 38 | increases the patient's cost-sharing obligations, or otherwise |
| 39 | increasing the patient's cost-sharing obligations for obtaining |
| 40 | the drug. This subsection does not prohibit an insurer from |
| 41 | making uniform changes in its benefit design which apply to all |
| 42 | covered drugs or from increasing cost-sharing obligations for a |
| 43 | drug due to a percentage coinsurance payment that increases in |
| 44 | proportion to an increase in the price of the drug. Any change |
| 45 | to a health insurance policy or a contract for a health care |
| 46 | service plan that covers prescription drugs is effective upon |
| 47 | the renewal of the policy or contract. The insurer shall |
| 48 | communicate this change and its effective date to the insured |
| 49 | during the open enrollment period. This section does not apply |
| 50 | to a managed care plan under the Medicaid program. |
| 51 | Section 2. Subsections (16) and (17) are added to section |
| 52 | 627.6561, Florida Statutes, to read: |
| 53 | 627.6561 Preexisting conditions.-- |
| 54 | (16) A health insurance policy or a contract for a health |
| 55 | care service plan that covers prescription drugs may not limit, |
| 56 | reduce, or deny coverage for a prescription drug to a particular |
| 57 | insured individual for the remainder of the current plan year |
| 58 | if, prior to the limitation, reduction, or denial of coverage: |
| 59 | (a) The insured was using the drug; |
| 60 | (b) The insured was covered under the policy or contract; |
| 61 | and |
| 62 | (c) The drug was covered under the policy or contract. |
| 63 | (17) A limitation, reduction, or denial of coverage |
| 64 | includes removing a drug from the formulary or other drug list, |
| 65 | imposing new management tools regarding prior authorization or |
| 66 | the use of the drug, placing the drug on a formulary tier that |
| 67 | increases the patient's cost-sharing obligations, or otherwise |
| 68 | increasing the patient's cost-sharing obligations for obtaining |
| 69 | the drug. This subsection does not prohibit an insurer from |
| 70 | making uniform changes in its benefit design which apply to all |
| 71 | covered drugs or from increasing cost-sharing obligations for a |
| 72 | drug due to a percentage coinsurance payment that increases in |
| 73 | proportion to an increase in the price of the drug. Any change |
| 74 | to a health insurance policy or a contract for a health care |
| 75 | service plan that covers prescription drugs is effective upon |
| 76 | the renewal of the policy or contract. The insurer shall |
| 77 | communicate this change and its effective date to the insured |
| 78 | during the open enrollment period. This section does not apply |
| 79 | to a managed care plan under the Medicaid program. |
| 80 | Section 3. Subsections (14) and (15) are added to section |
| 81 | 641.31071, Florida Statutes, to read: |
| 82 | 641.31071 Preexisting conditions.-- |
| 83 | (14) A health insurance policy or a contract for a health |
| 84 | care service plan that covers prescription drugs may not limit, |
| 85 | reduce, or deny coverage for a prescription drug to a particular |
| 86 | insured individual for the remainder of the current plan year |
| 87 | if, prior to the limitation, reduction, or denial of coverage: |
| 88 | (a) The insured was using the drug; |
| 89 | (b) The insured was covered under the policy or contract; |
| 90 | and |
| 91 | (c) The drug was covered under the policy or contract. |
| 92 | (15) A limitation, reduction, or denial of coverage |
| 93 | includes removing a drug from the formulary or other drug list, |
| 94 | imposing new management tools regarding prior authorization or |
| 95 | the use of the drug, placing the drug on a formulary tier that |
| 96 | increases the patient's cost-sharing obligations, or otherwise |
| 97 | increasing the patient's cost-sharing obligations for obtaining |
| 98 | the drug. This subsection does not prohibit an insurer from |
| 99 | making uniform changes in its benefit design which apply to all |
| 100 | covered drugs or from increasing cost-sharing obligations for a |
| 101 | drug due to a percentage coinsurance payment that increases in |
| 102 | proportion to an increase in the price of the drug. Any change |
| 103 | to a health insurance policy or a contract for a health care |
| 104 | service plan that covers prescription drugs is effective upon |
| 105 | the renewal of the policy or contract. The insurer shall |
| 106 | communicate this change and its effective date to the insured |
| 107 | during the open enrollment period. This section does not apply |
| 108 | to a managed care plan under the Medicaid program. |
| 109 | Section 4. This act shall take effect July 1, 2010. |