Florida Senate - 2016 COMMITTEE AMENDMENT
Bill No. SB 780
Ì217188JÎ217188
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
02/10/2016 .
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The Committee on Governmental Oversight and Accountability
(Hays) recommended the following:
1 Senate Substitute for Amendment (753432) (with title
2 amendment)
3
4 Delete everything after the enacting clause
5 and insert:
6 Section 1. Section 627.6442, Florida Statutes, is created
7 to read:
8 627.6442 Access to prescription drugs.—
9 (1) As used in this section:
10 (a) “Chronic illness” means human immunodeficiency virus
11 infection, epilepsy, hypertension, or diabetes.
12 (b) “Excluded drug” means a drug subject to restricted
13 distribution by the United States Food and Drug Administration
14 or a drug that requires special handling, provider coordination,
15 or patient education and cannot be provided by a retail
16 pharmacy.
17 (2) A health insurance policy issued, delivered, or renewed
18 in this state that provides major medical coverage and
19 prescription drug coverage may not require an insured to obtain
20 a prescription drug for the treatment of a chronic illness
21 exclusively from a mail order pharmacy, unless the prescription
22 drug is an excluded drug.
23 (3) An insured who elects not to use a mail order pharmacy
24 to obtain a prescription drug, other than an excluded drug,
25 prescribed for the treatment of a chronic illness may not be
26 required to pay a copayment or satisfy other conditions that are
27 not imposed on an insured who uses a mail order pharmacy if the
28 retail pharmacy used by the insured:
29 (a) Agrees to the same terms and conditions, including
30 credentialing, applicable to a mail order pharmacy; and
31 (b) Accepts payment or reimbursement from the insurer which
32 is no more than the amount that would be paid to a mail order
33 pharmacy for the same prescription drugs for the treatment of a
34 chronic illness.
35 (4) A health insurer that issues a major medical policy
36 that provides coverage for prescription drugs through a mail
37 order pharmacy shall disclose in the outline of coverage that an
38 insured may obtain prescription drugs for the treatment of a
39 chronic illness from a retail pharmacy, and that the exclusive
40 use of a mail order pharmacy is not required unless the drug is
41 an excluded drug.
42 (5) This section does not apply to grandfathered plans as
43 defined in s. 627.402, or to benefits set forth in s.
44 627.6561(5)(b), (c), (d), and (e).
45 Section 2. Section 627.6572, Florida Statutes, is created
46 to read:
47 627.6572 Access to prescription drugs.—
48 (1) As used in this section:
49 (a) “Chronic illness” means human immunodeficiency virus
50 infection, epilepsy, hypertension, or diabetes.
51 (b) “Excluded drug” means a drug subject to restricted
52 distribution by the United States Food and Drug Administration
53 or a drug that requires special handling, provider coordination,
54 or patient education and cannot be provided by a retail
55 pharmacy.
56 (2) A health insurance policy issued, delivered, or renewed
57 in this state that provides major medical coverage and
58 prescription drug coverage may not require an insured to obtain
59 a prescription drug for the treatment of a chronic illness
60 exclusively from a mail order pharmacy, unless the prescription
61 drug is an excluded drug.
62 (3) An insured who elects not to use a mail order pharmacy
63 to obtain a prescription drug, other than an excluded drug,
64 prescribed for the treatment of a chronic illness may not be
65 required to pay a copayment or satisfy other conditions that are
66 not imposed on an insured who uses a mail order pharmacy if the
67 retail pharmacy used by the insured:
68 (a) Agrees to the same terms and conditions, including
69 credentialing, applicable to a mail order pharmacy; and
70 (b) Accepts payment or reimbursement from the insurer which
71 is no more than the amount that would be paid to a mail order
72 pharmacy for the same prescription drugs for the treatment of a
73 chronic illness.
74 (4) A health insurer that issues a major medical policy
75 that provides coverage for prescription drugs through a mail
76 order pharmacy shall disclose in the outline of coverage that an
77 insured may obtain prescription drugs for the treatment of a
78 chronic illness from a retail pharmacy, and that the exclusive
79 use of a mail order pharmacy is not required unless the drug is
80 an excluded drug.
81 (5) This section does not apply to grandfathered plans as
82 defined in s. 627.402, or to benefits set forth in s.
83 627.6561(5)(b), (c), (d), and (e).
84 Section 3. Subsection (44) is added to section 641.31,
85 Florida Statutes, to read:
86 641.31 Health maintenance contracts.—
87 (44)(a) As used in this section:
88 1. “Chronic illness” means human immunodeficiency virus
89 infection, epilepsy, hypertension, or diabetes.
90 2. “Excluded drug” means a drug subject to restricted
91 distribution by the United States Food and Drug Administration
92 or a drug that requires special handling, provider coordination,
93 or patient education and cannot be provided by a retail
94 pharmacy.
95 (b) A health maintenance contract issued, delivered, or
96 renewed in this state that provides major medical coverage and
97 prescription drug coverage may not require a subscriber to
98 obtain a prescription drug for the treatment of a chronic
99 illness exclusively from a mail order pharmacy, unless the
100 prescription drug is an excluded drug.
101 (c) A subscriber who elects not to use a mail order
102 pharmacy to obtain a prescription drug, other than an excluded
103 drug, prescribed for the treatment of a chronic illness may not
104 be required to pay a copayment or satisfy other conditions that
105 are not imposed on a subscriber who uses a mail order pharmacy
106 if the retail pharmacy used by the subscriber:
107 1. Agrees to the same terms and conditions, including
108 credentialing, applicable to a mail order pharmacy; and
109 2. Accepts payment or reimbursement from the health
110 maintenance organization which is no more than the amount that
111 would be paid to a mail order pharmacy for the same prescription
112 drugs for the treatment of a chronic illness.
113 (d) A health maintenance organization that issues a health
114 maintenance contract that provides coverage for prescription
115 drugs through a mail order pharmacy shall disclose in the
116 outline of coverage that a subscriber may obtain prescription
117 drugs for the treatment of a chronic illness from a retail
118 pharmacy, and that the exclusive use of a mail order pharmacy is
119 not required unless the drug is an excluded drug.
120 (e) This section does not apply to grandfathered health
121 plans as defined in s. 641.313(1)(c), or to benefits set forth
122 in s. 641.31071(5)(b), (c), (d), and (e).
123 Section 4. This act shall take effect January 1, 2017.
124
125 ================= T I T L E A M E N D M E N T ================
126 And the title is amended as follows:
127 Delete everything before the enacting clause
128 and insert:
129 A bill to be entitled
130 An act relating to the provision of pharmaceutical
131 services; creating ss. 627.6442 and 627.6572, F.S.;
132 defining terms; providing that an insured may not be
133 required to obtain a prescription drug for the
134 treatment of a chronic illness exclusively from a mail
135 order pharmacy; providing an exception for excluded
136 drugs; prohibiting the imposition of copayments or
137 conditions on an insured living with a chronic illness
138 if such copayments or conditions are not imposed on an
139 insured who uses a mail order pharmacy that meets
140 certain requirements; requiring certain health
141 insurers to disclose in the outline of coverage that
142 an insured may obtain certain prescription drugs from
143 a retail pharmacy; providing an exception for excluded
144 drugs; providing applicability; amending s. 641.31,
145 F.S.; defining terms; providing that a health
146 maintenance organization subscriber may not be
147 required to obtain a prescription drug for the
148 treatment of a chronic illness exclusively from a mail
149 order pharmacy; providing an exception for excluded
150 drugs; prohibiting the imposition of copayments or
151 conditions on a subscriber living with a chronic
152 illness if such copayments or conditions are not
153 imposed on a subscriber who uses a mail order pharmacy
154 that meets certain requirements; requiring certain
155 health maintenance organizations to disclose in the
156 outline of coverage that a subscriber may obtain
157 certain prescription drugs from a retail pharmacy;
158 providing an exception for excluded drugs; providing
159 applicability; providing an effective date.