Florida Senate - 2018 SB 1494
By Senator Montford
3-00778D-18 20181494__
1 A bill to be entitled
2 An act relating to prescription drug pricing
3 transparency; amending s. 465.0244, F.S.; requiring a
4 pharmacist to inform a customer of a lower cost
5 alternative to a prescription and of whether the
6 customer’s cost-sharing obligation exceeds the retail
7 price of the prescription; creating s. 624.49, F.S.;
8 defining the term “pharmacy benefit manager”;
9 requiring a pharmacy benefit manager to register with
10 the Office of Insurance Regulation; providing
11 requirements and terms of registration, including the
12 payment of a registration fee; requiring the office to
13 issue certificates of registration and to set an
14 initial registration fee and a renewal fee; requiring
15 the office to adopt rules; creating ss. 627.64741 and
16 641.314, F.S.; defining the terms “maximum allowable
17 cost” and “pharmacy benefit manager”; requiring that
18 certain terms be included in a contract between a
19 health insurer or a health maintenance organization
20 and a pharmacy benefit manager, respectively;
21 providing applicability; providing an effective date.
22
23 Be It Enacted by the Legislature of the State of Florida:
24
25 Section 1. Section 465.0244, Florida Statutes, is amended
26 to read:
27 465.0244 Information disclosure.—
28 (1) Every pharmacy shall make available on its website a
29 hyperlink to the health information that is disseminated by the
30 Agency for Health Care Administration pursuant to s. 408.05(3)
31 and shall place in the area where customers receive filled
32 prescriptions a notice that such information is available
33 electronically and the address of its Internet website.
34 (2) In addition to the requirements of s. 465.025, a
35 pharmacist must inform a customer of a lower cost alternative
36 for his or her prescription and of whether the customer’s cost
37 sharing obligation exceeds the retail price of the prescription
38 in the absence of prescription drug coverage.
39 Section 2. Section 624.49, Florida Statutes, is created to
40 read:
41 624.49 Registration of pharmacy benefit managers.—
42 (1) As used in this section, “pharmacy benefit manager”
43 means a person or entity doing business in this state which
44 contracts to administer prescription drug benefits on behalf of
45 a health insurer or a health maintenance organization.
46 (2) To conduct business in this state, a pharmacy benefit
47 manager must register with the Office of Insurance Regulation.
48 To register, a pharmacy benefit manager must submit a fee
49 determined by the office, a copy of the registrant’s corporate
50 charter, articles of incorporation, or other charter document,
51 and a form established by the office containing the identity,
52 address, and either the social security number or taxpayer
53 identification number of all of the following persons:
54 (a) The registrant;
55 (b) The chief executive officer or a similarly titled
56 person responsible for the executive oversight of the
57 registrant;
58 (c) The chief financial officer or a similarly titled
59 person responsible for the financial oversight of the
60 registrant; and
61 (d) Each controlling interest of the registrant. For the
62 purpose of this section, “controlling interest” means a person
63 or entity that serves as an officer of, is on the board of
64 directors of, or has a 10 percent or greater ownership interest
65 in the registrant.
66 (3) The registrant shall report a change in any controlling
67 interest of the registrant to the office in writing within 30
68 days after the change.
69 (4) Upon receipt of a complete registration form and the
70 registration fee, the office shall issue a registration
71 certificate. The certificate may be in paper or electronic form,
72 and must clearly indicate the expiration date of the
73 registration. Registration certificates are nontransferable.
74 (5)(a) The term of registration shall be 2 years from the
75 date of issuance.
76 (b) The office shall set an initial registration fee and a
77 renewal fee, which are nonrefundable. Total fees may not exceed
78 the cost of administering this section.
79 (6) The office shall adopt rules necessary to administer
80 this section.
81 Section 3. Section 627.64741, Florida Statutes, is created
82 to read:
83 627.64741 Pharmacy benefit manager contracts.—
84 (1) As used in this section, the term:
85 (a) “Maximum allowable cost” means the per-unit amount that
86 a pharmacy benefit manager may reimburse a pharmacist for a
87 prescription drug, excluding dispensing fees, before the
88 application of copayments, coinsurance, or any other cost
89 sharing charges.
90 (b) “Pharmacy benefit manager” means a person or entity
91 doing business in this state which contracts to administer or
92 manage prescription drug benefits on behalf of a health insurer
93 to residents of this state.
94 (2) A contract between a health insurer and a pharmacy
95 benefit manager must include requirements that the pharmacy
96 benefit manager:
97 (a) Update maximum allowable cost information at least
98 every 7 calendar days; and
99 (b) Maintain a process that will, in a timely manner,
100 eliminate drugs from maximum allowable cost lists or modify drug
101 prices to remain consistent with changes in pricing data used in
102 formulating maximum allowable costs and product availability.
103 (3) A contract between a health insurer and a pharmacy
104 benefit manager must prohibit the pharmacy benefit manager from
105 limiting a pharmacy’s or pharmacist’s ability to substitute a
106 less expensive, generically equivalent drug product for a brand
107 name drug, pursuant to s. 465.025, or to disclose to a
108 subscriber whether the subscriber’s cost-sharing obligation
109 exceeds the retail price for a covered prescription drug, and
110 the availability of a more affordable alternative drug, pursuant
111 to s. 465.0244.
112 (4) A contract between a health insurer and a pharmacy
113 benefit manager must prohibit the pharmacy benefit manager from
114 requiring a subscriber to pay for a prescription drug at the
115 point of sale in an amount greater than the lesser of:
116 (a) The applicable cost-sharing amount;
117 (b) The allowable claim amount for the prescription drug;
118 and
119 (c) The retail price of the drug in the absence of
120 prescription drug coverage or programs that otherwise reduce the
121 cost of a drug to the patient.
122 (5) This section applies to contracts entered into or
123 renewed on or after July 1, 2018.
124 Section 4. Section 641.314, Florida Statutes, is created to
125 read:
126 641.314 Pharmacy benefit manager contracts.—
127 (1) As used in this section, the term:
128 (a) “Maximum allowable cost” means the per-unit amount that
129 a pharmacy benefit manager reimburses a pharmacist for a
130 prescription drug, excluding dispensing fees, before the
131 application of copayments, coinsurance, or any other cost
132 sharing charges.
133 (b) “Pharmacy benefit manager” means a person or entity
134 doing business in this state which contracts to administer or
135 manage prescription drug benefits on behalf of a health
136 maintenance organization to residents of this state.
137 (2) A contract between a health maintenance organization
138 and a pharmacy benefit manager must include requirements that
139 the pharmacy benefit manager:
140 (a) Update maximum allowable cost information at least
141 every 7 calendar days; and
142 (b) Maintain a process that will, in a timely manner,
143 eliminate drugs from maximum allowable cost lists or modify drug
144 prices to remain consistent with changes in pricing data used in
145 formulating maximum allowable costs and product availability.
146 (3) A contract between a health maintenance organization
147 and a pharmacy benefit manager must prohibit the pharmacy
148 benefit manager from limiting a pharmacy’s or pharmacist’s
149 ability to substitute a less expensive, generically equivalent
150 drug product for a brand name drug, pursuant to s. 465.025, or
151 to disclose to a subscriber whether the subscriber’s cost
152 sharing obligation exceeds the retail price for a covered
153 prescription drug, and the availability of a more affordable
154 alternative drug, pursuant to s. 465.0244.
155 (4) A contract between a health maintenance organization
156 and a pharmacy benefit manager must prohibit the pharmacy
157 benefit manager from requiring a subscriber to pay for a
158 prescription drug at the point of sale in an amount greater than
159 the lesser of:
160 (a) The applicable cost-sharing amount;
161 (b) The allowable claim amount for the prescription drug;
162 and
163 (c) The retail price of the drug in the absence of
164 prescription drug coverage or programs that otherwise reduce the
165 cost of a drug to the patient.
166 (5) This section applies to contracts entered into or
167 renewed on or after July 1, 2018.
168 Section 5. This act shall take effect July 1, 2018.