Florida Senate - 2016 CS for SB 780
By the Committee on Governmental Oversight and Accountability;
and Senator Garcia
585-03243-16 2016780c1
1 A bill to be entitled
2 An act relating to the provision of pharmaceutical
3 services; creating ss. 627.6442 and 627.6572, F.S.;
4 defining terms; providing that an insured may not be
5 required to obtain a prescription drug for the
6 treatment of a chronic illness exclusively from a mail
7 order pharmacy; providing an exception for excluded
8 drugs; prohibiting the imposition of copayments or
9 conditions on an insured living with a chronic illness
10 if such copayments or conditions are not imposed on an
11 insured who uses a mail order pharmacy that meets
12 certain requirements; requiring certain health
13 insurers to disclose in the outline of coverage that
14 an insured may obtain certain prescription drugs from
15 a retail pharmacy; providing an exception for excluded
16 drugs; providing applicability; amending s. 641.31,
17 F.S.; defining terms; providing that a health
18 maintenance organization subscriber may not be
19 required to obtain a prescription drug for the
20 treatment of a chronic illness exclusively from a mail
21 order pharmacy; providing an exception for excluded
22 drugs; prohibiting the imposition of copayments or
23 conditions on a subscriber living with a chronic
24 illness if such copayments or conditions are not
25 imposed on a subscriber who uses a mail order pharmacy
26 that meets certain requirements; requiring certain
27 health maintenance organizations to disclose in the
28 outline of coverage that a subscriber may obtain
29 certain prescription drugs from a retail pharmacy;
30 providing an exception for excluded drugs; providing
31 applicability; providing an effective date.
32
33 Be It Enacted by the Legislature of the State of Florida:
34
35 Section 1. Section 627.6442, Florida Statutes, is created
36 to read:
37 627.6442 Access to prescription drugs.—
38 (1) As used in this section:
39 (a) “Chronic illness” means human immunodeficiency virus
40 infection, epilepsy, hypertension, or diabetes.
41 (b) “Excluded drug” means a drug subject to restricted
42 distribution by the United States Food and Drug Administration
43 or a drug that requires special handling, provider coordination,
44 or patient education and cannot be provided by a retail
45 pharmacy.
46 (2) A health insurance policy issued, delivered, or renewed
47 in this state that provides major medical coverage and
48 prescription drug coverage may not require an insured to obtain
49 a prescription drug for the treatment of a chronic illness
50 exclusively from a mail order pharmacy, unless the prescription
51 drug is an excluded drug.
52 (3) An insured who elects not to use a mail order pharmacy
53 to obtain a prescription drug, other than an excluded drug,
54 prescribed for the treatment of a chronic illness may not be
55 required to pay a copayment or satisfy other conditions that are
56 not imposed on an insured who uses a mail order pharmacy if the
57 retail pharmacy used by the insured:
58 (a) Agrees to the same terms and conditions, including
59 credentialing, applicable to a mail order pharmacy; and
60 (b) Accepts payment or reimbursement from the insurer which
61 is no more than the amount that would be paid to a mail order
62 pharmacy for the same prescription drugs for the treatment of a
63 chronic illness.
64 (4) A health insurer that issues a major medical policy
65 that provides coverage for prescription drugs through a mail
66 order pharmacy shall disclose in the outline of coverage that an
67 insured may obtain prescription drugs for the treatment of a
68 chronic illness from a retail pharmacy, and that the exclusive
69 use of a mail order pharmacy is not required unless the drug is
70 an excluded drug.
71 (5) This section does not apply to grandfathered plans as
72 defined in s. 627.402, or to benefits set forth in s.
73 627.6561(5)(b), (c), (d), and (e).
74 Section 2. Section 627.6572, Florida Statutes, is created
75 to read:
76 627.6572 Access to prescription drugs.—
77 (1) As used in this section:
78 (a) “Chronic illness” means human immunodeficiency virus
79 infection, epilepsy, hypertension, or diabetes.
80 (b) “Excluded drug” means a drug subject to restricted
81 distribution by the United States Food and Drug Administration
82 or a drug that requires special handling, provider coordination,
83 or patient education and cannot be provided by a retail
84 pharmacy.
85 (2) A health insurance policy issued, delivered, or renewed
86 in this state that provides major medical coverage and
87 prescription drug coverage may not require an insured to obtain
88 a prescription drug for the treatment of a chronic illness
89 exclusively from a mail order pharmacy, unless the prescription
90 drug is an excluded drug.
91 (3) An insured who elects not to use a mail order pharmacy
92 to obtain a prescription drug, other than an excluded drug,
93 prescribed for the treatment of a chronic illness may not be
94 required to pay a copayment or satisfy other conditions that are
95 not imposed on an insured who uses a mail order pharmacy if the
96 retail pharmacy used by the insured:
97 (a) Agrees to the same terms and conditions, including
98 credentialing, applicable to a mail order pharmacy; and
99 (b) Accepts payment or reimbursement from the insurer which
100 is no more than the amount that would be paid to a mail order
101 pharmacy for the same prescription drugs for the treatment of a
102 chronic illness.
103 (4) A health insurer that issues a major medical policy
104 that provides coverage for prescription drugs through a mail
105 order pharmacy shall disclose in the outline of coverage that an
106 insured may obtain prescription drugs for the treatment of a
107 chronic illness from a retail pharmacy, and that the exclusive
108 use of a mail order pharmacy is not required unless the drug is
109 an excluded drug.
110 (5) This section does not apply to grandfathered plans as
111 defined in s. 627.402, or to benefits set forth in s.
112 627.6561(5)(b), (c), (d), and (e).
113 Section 3. Subsection (44) is added to section 641.31,
114 Florida Statutes, to read:
115 641.31 Health maintenance contracts.—
116 (44)(a) As used in this section:
117 1. “Chronic illness” means human immunodeficiency virus
118 infection, epilepsy, hypertension, or diabetes.
119 2. “Excluded drug” means a drug subject to restricted
120 distribution by the United States Food and Drug Administration
121 or a drug that requires special handling, provider coordination,
122 or patient education and cannot be provided by a retail
123 pharmacy.
124 (b) A health maintenance contract issued, delivered, or
125 renewed in this state that provides major medical coverage and
126 prescription drug coverage may not require a subscriber to
127 obtain a prescription drug for the treatment of a chronic
128 illness exclusively from a mail order pharmacy, unless the
129 prescription drug is an excluded drug.
130 (c) A subscriber who elects not to use a mail order
131 pharmacy to obtain a prescription drug, other than an excluded
132 drug, prescribed for the treatment of a chronic illness may not
133 be required to pay a copayment or satisfy other conditions that
134 are not imposed on a subscriber who uses a mail order pharmacy
135 if the retail pharmacy used by the subscriber:
136 1. Agrees to the same terms and conditions, including
137 credentialing, applicable to a mail order pharmacy; and
138 2. Accepts payment or reimbursement from the health
139 maintenance organization which is no more than the amount that
140 would be paid to a mail order pharmacy for the same prescription
141 drugs for the treatment of a chronic illness.
142 (d) A health maintenance organization that issues a health
143 maintenance contract that provides coverage for prescription
144 drugs through a mail order pharmacy shall disclose in the
145 outline of coverage that a subscriber may obtain prescription
146 drugs for the treatment of a chronic illness from a retail
147 pharmacy, and that the exclusive use of a mail order pharmacy is
148 not required unless the drug is an excluded drug.
149 (e) This section does not apply to grandfathered health
150 plans as defined in s. 641.313(1)(c), or to benefits set forth
151 in s. 641.31071(5)(b), (c), (d), and (e).
152 Section 4. This act shall take effect January 1, 2017.