Florida Senate - 2017                       CS for CS for SB 182
       
       
        
       By the Committees on Health Policy; and Banking and Insurance;
       and Senator Mayfield
       
       
       
       
       588-01933-17                                           2017182c2
    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, under specified
    5         circumstances, changes to a health insurance policy
    6         prescription drug formulary during a policy year;
    7         providing construction and applicability; amending s.
    8         627.6699, F.S.; requiring small employer carriers to
    9         limit changes to prescription drug formularies under
   10         certain circumstances; amending s. 641.31, F.S.;
   11         limiting, under specified circumstances, changes to a
   12         health maintenance contract prescription drug
   13         formulary during a contract year; providing
   14         construction and applicability; providing a
   15         declaration of important state interest; providing an
   16         effective date.
   17          
   18  Be It Enacted by the Legislature of the State of Florida:
   19  
   20         Section 1. Section 627.42393, Florida Statutes, is created
   21  to read:
   22         627.42393Insurance policies; limiting changes to
   23  prescription drug formularies.—
   24         (1)Other than at the time of coverage renewal, an
   25  individual or group insurance policy that is delivered, issued
   26  for delivery, renewed, amended, or continued in this state and
   27  that provides medical, major medical, or similar comprehensive
   28  coverage may not:
   29         (a)Remove a covered prescription drug from its list of
   30  covered drugs during the policy year unless the United States
   31  Food and Drug Administration has issued a statement about the
   32  drug which calls into question the clinical safety of the drug,
   33  or the manufacturer of the drug has notified the United States
   34  Food and Drug Administration of a manufacturing discontinuance
   35  or potential discontinuance of the drug as required by s. 506C
   36  of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
   37         (b)Reclassify a drug to a more restrictive drug tier or
   38  increase the amount that an insured must pay for a copayment,
   39  coinsurance, or deductible for prescription drug benefits, or
   40  reclassify a drug to a higher cost-sharing tier during the
   41  policy year.
   42         (2)This section does not prohibit the addition of
   43  prescription drugs to the list of drugs covered under the policy
   44  during the policy year.
   45         (3)This section does not apply to a grandfathered health
   46  plan as defined in s. 627.402 or to benefits set forth in s.
   47  627.6513(1)-(14).
   48         (4)This section does not alter or amend s. 465.025, which
   49  provides conditions under which a pharmacist may substitute a
   50  generically equivalent drug product for a brand name drug
   51  product.
   52         (5)This section does not alter or amend s. 465.0252, which
   53  provides conditions under which a pharmacist may dispense a
   54  substitute biological product for the prescribed biological
   55  product.
   56         Section 2. Paragraph (e) of subsection (5) of section
   57  627.6699, Florida Statutes, is amended to read:
   58         627.6699 Employee Health Care Access Act.—
   59         (5) AVAILABILITY OF COVERAGE.—
   60         (e) All health benefit plans issued under this section must
   61  comply with the following conditions:
   62         1. For employers who have fewer than two employees, a late
   63  enrollee may be excluded from coverage for no longer than 24
   64  months if he or she was not covered by creditable coverage
   65  continually to a date not more than 63 days before the effective
   66  date of his or her new coverage.
   67         2. Any requirement used by a small employer carrier in
   68  determining whether to provide coverage to a small employer
   69  group, including requirements for minimum participation of
   70  eligible employees and minimum employer contributions, must be
   71  applied uniformly among all small employer groups having the
   72  same number of eligible employees applying for coverage or
   73  receiving coverage from the small employer carrier, except that
   74  a small employer carrier that participates in, administers, or
   75  issues health benefits pursuant to s. 381.0406 which do not
   76  include a preexisting condition exclusion may require as a
   77  condition of offering such benefits that the employer has had no
   78  health insurance coverage for its employees for a period of at
   79  least 6 months. A small employer carrier may vary application of
   80  minimum participation requirements and minimum employer
   81  contribution requirements only by the size of the small employer
   82  group.
   83         3. In applying minimum participation requirements with
   84  respect to a small employer, a small employer carrier shall not
   85  consider as an eligible employee employees or dependents who
   86  have qualifying existing coverage in an employer-based group
   87  insurance plan or an ERISA qualified self-insurance plan in
   88  determining whether the applicable percentage of participation
   89  is met. However, a small employer carrier may count eligible
   90  employees and dependents who have coverage under another health
   91  plan that is sponsored by that employer.
   92         4. A small employer carrier shall not increase any
   93  requirement for minimum employee participation or any
   94  requirement for minimum employer contribution applicable to a
   95  small employer at any time after the small employer has been
   96  accepted for coverage, unless the employer size has changed, in
   97  which case the small employer carrier may apply the requirements
   98  that are applicable to the new group size.
   99         5. If a small employer carrier offers coverage to a small
  100  employer, it must offer coverage to all the small employer’s
  101  eligible employees and their dependents. A small employer
  102  carrier may not offer coverage limited to certain persons in a
  103  group or to part of a group, except with respect to late
  104  enrollees.
  105         6. A small employer carrier may not modify any health
  106  benefit plan issued to a small employer with respect to a small
  107  employer or any eligible employee or dependent through riders,
  108  endorsements, or otherwise to restrict or exclude coverage for
  109  certain diseases or medical conditions otherwise covered by the
  110  health benefit plan.
  111         7. An initial enrollment period of at least 30 days must be
  112  provided. An annual 30-day open enrollment period must be
  113  offered to each small employer’s eligible employees and their
  114  dependents. A small employer carrier must provide special
  115  enrollment periods as required by s. 627.65615.
  116         8. A small employer carrier must limit changes to
  117  prescription drug formularies as required by s. 627.42393.
  118         Section 3. Subsection (36) of section 641.31, Florida
  119  Statutes, is amended to read:
  120         641.31 Health maintenance contracts.—
  121         (36) A health maintenance organization may increase the
  122  copayment for any benefit, or delete, amend, or limit any of the
  123  benefits to which a subscriber is entitled under the group
  124  contract only, upon written notice to the contract holder at
  125  least 45 days in advance of the time of coverage renewal. The
  126  health maintenance organization may amend the contract with the
  127  contract holder, with such amendment to be effective immediately
  128  at the time of coverage renewal. The written notice to the
  129  contract holder must shall specifically identify any deletions,
  130  amendments, or limitations to any of the benefits provided in
  131  the group contract during the current contract period which will
  132  be included in the group contract upon renewal. This subsection
  133  does not apply to any increases in benefits. The 45-day notice
  134  requirement does shall not apply if benefits are amended,
  135  deleted, or limited at the request of the contract holder.
  136         (a) Other than at the time of coverage renewal, a health
  137  maintenance organization that provides medical, major medical,
  138  or similar comprehensive coverage may not:
  139         1. Remove a covered prescription drug from its list of
  140  covered drugs during the contract year unless the United States
  141  Food and Drug Administration has issued a statement about the
  142  drug which calls into question the clinical safety of the drug,
  143  or the manufacturer of the drug has notified the United States
  144  Food and Drug Administration of a manufacturing discontinuance
  145  or potential discontinuance of the drug as required by s. 506C
  146  of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
  147         2. Reclassify a drug to a more restrictive drug tier or
  148  increase the amount that an insured must pay for a copayment,
  149  coinsurance, or deductible for prescription drug benefits, or
  150  reclassify a drug to a higher cost-sharing tier during the
  151  contract year.
  152         (b) This subsection does not:
  153         1. Prohibit the addition of prescription drugs to the list
  154  of drugs covered during the contract year.
  155         2. Apply to a grandfathered health plan as defined in s.
  156  627.402 or to benefits set forth in s. 627.6513(1)-(14).
  157         3. Alter or amend s. 465.025, which provides conditions
  158  under which a pharmacist may substitute a generically equivalent
  159  drug product for a brand name drug product.
  160         4. Alter or amend s. 465.0252, which provides conditions
  161  under which a pharmacist may dispense a substitute biological
  162  product for the prescribed biological product.
  163         Section 4. The Legislature finds that this act fulfills an
  164  important state interest.
  165         Section 5. This act shall take effect January 1, 2018.