Florida Senate - 2018                        COMMITTEE AMENDMENT
       Bill No. SB 1494
       
       
       
       
       
       
                                Ì167480/Î167480                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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       The Committee on Health Policy (Montford) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 465.0244, Florida Statutes, is amended
    6  to read:
    7         465.0244 Information disclosure.—
    8         (1) Every pharmacy shall make available on its website a
    9  hyperlink to the health information that is disseminated by the
   10  Agency for Health Care Administration pursuant to s. 408.05(3)
   11  and shall place in the area where customers receive filled
   12  prescriptions notice that such information is available
   13  electronically and the address of its Internet website.
   14         (2)In addition to the requirements of s. 465.025, a
   15  pharmacist or her or his authorized employee must inform a
   16  customer of a less expensive, generically equivalent drug
   17  product for her or his prescription and as to whether the
   18  customer’s cost-sharing obligation exceeds the retail price of
   19  the prescription in the absence of prescription drug coverage.
   20         Section 2. Section 465.1862, Florida Statutes, is repealed.
   21         Section 3. Section 624.490, Florida Statutes, is created to
   22  read:
   23         624.490Registration of pharmacy benefit managers.—
   24         (1)As used in this section, the term “pharmacy benefit
   25  manager” means a person or entity doing business in this state
   26  which contracts to administer prescription drug benefits on
   27  behalf of a health insurer or a health maintenance organization
   28  to residents of this state.
   29         (2)To conduct business in this state, a pharmacy benefit
   30  manager must register with the office. To register, a pharmacy
   31  benefit manager shall submit:
   32         (a)A fee determined by the office.
   33         (b)A copy of the registrant’s corporate charter, articles
   34  of incorporation, or other charter document.
   35         (c)A form established by the office containing the
   36  identity, address, and taxpayer identification number, when
   37  applicable, of:
   38         1.The registrant.
   39         2.The chief executive officer or a similarly titled person
   40  responsible for the executive oversight of the registrant.
   41         3.The chief financial officer or a similarly titled person
   42  responsible for the financial oversight of the registrant.
   43         4.Each person or entity responsible for the affairs of the
   44  registrant, including, but not limited to, the day-to-day
   45  operations of the registrant.
   46         (3)The registrant shall report any change in information
   47  required by subsection (2) to the office in writing within 60
   48  days after the change occurs.
   49         (4)Upon receipt of a completed registration form and the
   50  registration fee, the office shall issue a registration
   51  certificate. The certificate may be in paper or electronic form,
   52  and shall clearly indicate the expiration date of the
   53  registration. Registration certificates are nontransferable.
   54         (5)A registration certificate is valid for 2 years from
   55  its date of issue. The office shall set an initial registration
   56  fee and a registration renewal fee, both of which shall be
   57  nonrefundable. Total fees may not exceed the cost of
   58  administering this section or $500, whichever is less.
   59         (6)The office shall adopt rules necessary to implement
   60  this section.
   61         Section 4. Section 627.64741, Florida Statutes, is created
   62  to read:
   63         627.64741Pharmacy benefit manager contracts.—
   64         (1)As used in this section, the term:
   65         (a)“Maximum allowable cost” means the per-unit amount that
   66  a pharmacy benefit manager reimburses a pharmacist for a
   67  prescription drug, excluding dispensing fees, prior to the
   68  application of copayments, coinsurance, and other cost-sharing
   69  charges, if any.
   70         (b)“Pharmacy benefit manager” means a person or entity
   71  doing business in this state which contracts to administer or
   72  manage prescription drug benefits on behalf of a health insurer
   73  to residents of this state.
   74         (2)A contract between a health insurer and a pharmacy
   75  benefit manager must require that the pharmacy benefit manager:
   76         (a)Update maximum allowable cost pricing information at
   77  least every 7 calendar days.
   78         (b)Maintain a process that will, in a timely manner,
   79  eliminate drugs from maximum allowable cost lists or modify drug
   80  prices to remain consistent with changes in pricing data used in
   81  formulating maximum allowable cost prices and product
   82  availability.
   83         (3)A contract between a health insurer and a pharmacy
   84  benefit manager must prohibit the pharmacy benefit manager from
   85  limiting a pharmacist’s ability to disclose whether the cost
   86  sharing obligation exceeds the retail price for a covered
   87  prescription drug, and the availability of a more affordable
   88  alternative drug, pursuant to s. 465.0244.
   89         (4)A contract between a health insurer and a pharmacy
   90  benefit manager must prohibit the pharmacy benefit manager from
   91  requiring an insured to make a payment for a prescription drug
   92  at the point of sale in an amount that exceeds the lesser of:
   93         (a)The applicable cost-sharing amount; or
   94         (b)The retail price of the drug in the absence of
   95  prescription drug coverage.
   96         (5) This section applies to contracts entered into or
   97  renewed on or after July 1, 2018.
   98         Section 5. Section 627.6572, Florida Statutes, is created
   99  to read:
  100         627.6572Pharmacy benefit manager contracts.—
  101         (1)As used in this section, the term:
  102         (a)“Maximum allowable cost” means the per-unit amount that
  103  a pharmacy benefit manager reimburses a pharmacist for a
  104  prescription drug, excluding dispensing fees, prior to the
  105  application of copayments, coinsurance, and any other cost
  106  sharing charges.
  107         (b)“Pharmacy benefit manager” means a person or entity
  108  doing business in this state which contracts to administer or
  109  manage prescription drug benefits on behalf of a health insurer
  110  to residents of this state.
  111         (2)A contract between a health insurer and a pharmacy
  112  benefit manager must require that the pharmacy benefit manager:
  113         (a)Update maximum allowable cost pricing information at
  114  least every 7 calendar days.
  115         (b)Maintain a process that will, in a timely manner,
  116  eliminate drugs from maximum allowable cost lists or modify drug
  117  prices to remain consistent with changes in pricing data used in
  118  formulating maximum allowable cost prices and product
  119  availability.
  120         (3)A contract between a health insurer and a pharmacy
  121  benefit manager must prohibit the pharmacy benefit manager from
  122  limiting a pharmacist’s ability to disclose whether the cost
  123  sharing obligation exceeds the retail price for a covered
  124  prescription drug, and the availability of a more affordable
  125  alternative drug, pursuant to s. 465.0244.
  126         (4)A contract between a health insurer and a pharmacy
  127  benefit manager must prohibit the pharmacy benefit manager from
  128  requiring an insured to make a payment for a prescription drug
  129  at the point of sale in an amount that exceeds the lesser of:
  130         (a)The applicable cost-sharing amount; or
  131         (b)The retail price of the drug in the absence of
  132  prescription drug coverage.
  133         (5) This section applies to contracts entered into or
  134  renewed on or after July 1, 2018.
  135         Section 6. Section 641.314, Florida Statutes, is created to
  136  read:
  137         641.314Pharmacy benefit manager contracts.—
  138         (1)As used in this section, the term:
  139         (a)“Maximum allowable cost” means the per-unit amount that
  140  a pharmacy benefit manager reimburses a pharmacist for a
  141  prescription drug, excluding dispensing fees, prior to the
  142  application of copayments, coinsurance, and any other cost
  143  sharing charges.
  144         (b)“Pharmacy benefit manager” means a person or entity
  145  doing business in this state which contracts to administer or
  146  manage prescription drug benefits on behalf of a health
  147  maintenance organization to residents of this state.
  148         (2)A contract between a health maintenance organization
  149  and a pharmacy benefit manager must require that the pharmacy
  150  benefit manager:
  151         (a)Update maximum allowable cost pricing information at
  152  least every 7 calendar days.
  153         (b)Maintain a process that will, in a timely manner,
  154  eliminate drugs from maximum allowable cost lists or modify drug
  155  prices to remain consistent with changes in pricing data used in
  156  formulating maximum allowable cost prices and product
  157  availability.
  158         (3)A contract between a health maintenance organization
  159  and a pharmacy benefit manager must prohibit the pharmacy
  160  benefit manager from limiting a pharmacist’s ability to disclose
  161  whether the cost-sharing obligation exceeds the retail price for
  162  a covered prescription drug, and the availability of a more
  163  affordable alternative drug, pursuant to s. 465.0244.
  164         (4)A contract between a health maintenance organization
  165  and a pharmacy benefit manager must prohibit the pharmacy
  166  benefit manager from requiring a subscriber to make a payment
  167  for a prescription drug at the point of sale in an amount that
  168  exceeds the lesser of:
  169         (a)The applicable cost-sharing amount; or
  170         (b)The retail price of the drug in the absence of
  171  prescription drug coverage or programs that reduce the cost of a
  172  drug to the patient.
  173         (5) This section applies to contracts entered into or
  174  renewed on or after July 1, 2018.
  175         Section 7. This act shall take effect July 1, 2018.
  176  
  177  ================= T I T L E  A M E N D M E N T ================
  178  And the title is amended as follows:
  179         Delete everything before the enacting clause
  180  and insert:
  181                        A bill to be entitled                      
  182         An act relating to prescription drug pricing
  183         transparency; amending s. 465.0244, F.S.; requiring
  184         pharmacists to inform customers of less expensive,
  185         generically equivalent drugs for their prescriptions
  186         and as to whether customers’ cost-sharing obligations
  187         exceed the retail price of their prescriptions;
  188         repealing s. 465.1862, F.S., relating to pharmacy
  189         benefit manager contracts; creating s. 624.490, F.S.;
  190         defining the term “pharmacy benefit manager”;
  191         requiring a pharmacy benefit manager to register with
  192         the Office of Insurance Regulation; providing
  193         requirements and terms of registration, including the
  194         payment of a registration fee; requiring the office to
  195         issue certificates of registration and to set an
  196         initial registration fee and a renewal fee, which may
  197         not exceed a specified amount; requiring the office to
  198         adopt rules; creating ss. 627.64741, 627.6572, and
  199         641.314, F.S.; defining the terms “maximum allowable
  200         cost” and “pharmacy benefit manager”; requiring that
  201         certain terms be included in a contract between a
  202         health insurer or a health maintenance organization
  203         and a pharmacy benefit manager; providing
  204         applicability; providing an effective date.