Florida Senate - 2017 SB 182
By Senator Mayfield
17-00357-17 2017182__
1 A bill to be entitled
2 An act relating to consumer protection from nonmedical
3 changes to prescription drug formularies; creating s.
4 627.42393, F.S.; limiting changes to a health
5 insurance policy prescription drug formulary during a
6 policy year; providing applicability and construction;
7 amending s. 627.6699, F.S.; requiring small employer
8 carriers to provide continuity of care for certain
9 patients with respect to prescription drug coverage;
10 amending s. 641.31, F.S.; limiting changes to a health
11 maintenance contract prescription drug formulary
12 during a contract year; providing applicability and
13 construction; providing an effective date.
14
15 Be It Enacted by the Legislature of the State of Florida:
16
17 Section 1. Section 627.42393, Florida Statutes, is created
18 to read:
19 627.42393 Insurance policies; limiting changes to
20 prescription drug formularies.—
21 (1) Other than during an open enrollment period, an
22 individual or group insurance policy that is delivered, issued
23 for delivery, renewed, amended, or continued in this state and
24 that provides medical, major medical, or similar comprehensive
25 coverage may not:
26 (a) Remove a covered prescription drug from its list of
27 covered drugs during the policy year unless the United States
28 Food and Drug Administration has issued a statement about the
29 drug which calls into question the clinical safety of the drug,
30 or the manufacturer of the drug has notified the United States
31 Food and Drug Administration of a manufacturing discontinuance
32 or potential discontinuance of the drug as required by s. 506C
33 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
34 (b) Reclassify a drug to a more restrictive drug tier or
35 increase the amount that an insured must pay for a copayment,
36 coinsurance, or deductible for prescription drug benefits, or
37 reclassify a drug to a higher cost-sharing tier during the
38 policy year.
39 (2) This section does not prohibit the addition of
40 prescription drugs to the list of drugs covered under the policy
41 during the policy year.
42 (3) This section does not apply to a grandfathered health
43 plan as defined in s. 627.402 or to benefits set forth in s.
44 627.6513(1)-(14).
45 (4) This section does not alter or amend s. 465.025, which
46 provides conditions under which a pharmacist may substitute a
47 generically equivalent drug product for a brand name drug
48 product.
49 (5) This section does not alter or amend s. 465.0252, which
50 provides conditions under which a pharmacist may dispense a
51 substitute biological product for the prescribed biological
52 product.
53 Section 2. Paragraph (e) of subsection (5) of section
54 627.6699, Florida Statutes, is amended to read:
55 627.6699 Employee Health Care Access Act.—
56 (5) AVAILABILITY OF COVERAGE.—
57 (e) All health benefit plans issued under this section must
58 comply with the following conditions:
59 1. For employers who have fewer than two employees, a late
60 enrollee may be excluded from coverage for no longer than 24
61 months if he or she was not covered by creditable coverage
62 continually to a date not more than 63 days before the effective
63 date of his or her new coverage.
64 2. Any requirement used by a small employer carrier in
65 determining whether to provide coverage to a small employer
66 group, including requirements for minimum participation of
67 eligible employees and minimum employer contributions, must be
68 applied uniformly among all small employer groups having the
69 same number of eligible employees applying for coverage or
70 receiving coverage from the small employer carrier, except that
71 a small employer carrier that participates in, administers, or
72 issues health benefits pursuant to s. 381.0406 which do not
73 include a preexisting condition exclusion may require as a
74 condition of offering such benefits that the employer has had no
75 health insurance coverage for its employees for a period of at
76 least 6 months. A small employer carrier may vary application of
77 minimum participation requirements and minimum employer
78 contribution requirements only by the size of the small employer
79 group.
80 3. In applying minimum participation requirements with
81 respect to a small employer, a small employer carrier shall not
82 consider as an eligible employee employees or dependents who
83 have qualifying existing coverage in an employer-based group
84 insurance plan or an ERISA qualified self-insurance plan in
85 determining whether the applicable percentage of participation
86 is met. However, a small employer carrier may count eligible
87 employees and dependents who have coverage under another health
88 plan that is sponsored by that employer.
89 4. A small employer carrier shall not increase any
90 requirement for minimum employee participation or any
91 requirement for minimum employer contribution applicable to a
92 small employer at any time after the small employer has been
93 accepted for coverage, unless the employer size has changed, in
94 which case the small employer carrier may apply the requirements
95 that are applicable to the new group size.
96 5. If a small employer carrier offers coverage to a small
97 employer, it must offer coverage to all the small employer’s
98 eligible employees and their dependents. A small employer
99 carrier may not offer coverage limited to certain persons in a
100 group or to part of a group, except with respect to late
101 enrollees.
102 6. A small employer carrier may not modify any health
103 benefit plan issued to a small employer with respect to a small
104 employer or any eligible employee or dependent through riders,
105 endorsements, or otherwise to restrict or exclude coverage for
106 certain diseases or medical conditions otherwise covered by the
107 health benefit plan.
108 7. An initial enrollment period of at least 30 days must be
109 provided. An annual 30-day open enrollment period must be
110 offered to each small employer’s eligible employees and their
111 dependents. A small employer carrier must provide special
112 enrollment periods as required by s. 627.65615.
113 8. A small employer carrier must provide continuity of care
114 for medically stable patients as required by s. 627.42393.
115 Section 3. Subsection (44) is added to section 641.31,
116 Florida Statutes, to read:
117 641.31 Health maintenance contracts.—
118 (44)(a) Other than during an open enrollment period, a
119 health maintenance contract that is delivered, issued for
120 delivery, renewed, amended, or continued in this state and that
121 provides medical, major medical, or similar comprehensive
122 coverage may not:
123 1. Remove a covered prescription drug from its list of
124 covered drugs during the contract year unless the United States
125 Food and Drug Administration has issued a statement about the
126 drug which calls into question the clinical safety of the drug,
127 or the manufacturer of the drug has notified the United States
128 Food and Drug Administration of a manufacturing discontinuance
129 or potential discontinuance of the drug as required by s. 506C
130 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
131 2. Reclassify a drug to a more restrictive drug tier or
132 increase the amount that an insured must pay for a copayment,
133 coinsurance, or deductible for prescription drug benefits, or
134 reclassify a drug to a higher cost-sharing tier during the
135 contract year.
136 (b) This subsection does not prohibit the addition of
137 prescription drugs to the list of drugs covered during the
138 contract year.
139 (c) This subsection does not apply to a grandfathered
140 health plan as defined in s. 627.402 or to benefits set forth in
141 s. 627.6513(1)-(14).
142 (d) This subsection does not alter or amend s. 465.025,
143 which provides conditions under which a pharmacist may
144 substitute a generically equivalent drug product for a brand
145 name drug product.
146 (e) This subsection does not alter or amend s. 465.0252,
147 which provides conditions under which a pharmacist may dispense
148 a substitute biological product for the prescribed biological
149 product.
150 Section 4. This act shall take effect January 1, 2018.