Florida Senate - 2018 CS for SB 1494 By the Committee on Health Policy; and Senators Montford and Grimsley 588-02927-18 20181494c1 1 A bill to be entitled 2 An act relating to prescription drug pricing 3 transparency; amending s. 465.0244, F.S.; requiring 4 pharmacists to inform customers of less expensive, 5 generically equivalent drugs for their prescriptions 6 and as to whether customers’ cost-sharing obligations 7 exceed the retail price of their prescriptions; 8 repealing s. 465.1862, F.S., relating to pharmacy 9 benefit manager contracts; creating s. 624.490, F.S.; 10 defining the term “pharmacy benefit manager”; 11 requiring a pharmacy benefit manager to register with 12 the Office of Insurance Regulation; providing 13 requirements and terms of registration, including the 14 payment of a registration fee; requiring the office to 15 issue certificates of registration and to set an 16 initial registration fee and a renewal fee, which may 17 not exceed a specified amount; requiring the office to 18 adopt rules; creating ss. 627.64741, 627.6572, and 19 641.314, F.S.; defining the terms “maximum allowable 20 cost” and “pharmacy benefit manager”; requiring that 21 certain terms be included in a contract between a 22 health insurer or a health maintenance organization 23 and a pharmacy benefit manager; providing 24 applicability; providing an effective date. 25 26 Be It Enacted by the Legislature of the State of Florida: 27 28 Section 1. Section 465.0244, Florida Statutes, is amended 29 to read: 30 465.0244 Information disclosure.— 31 (1) Every pharmacy shall make available on its website a 32 hyperlink to the health information that is disseminated by the 33 Agency for Health Care Administration pursuant to s. 408.05(3) 34 and shall place in the area where customers receive filled 35 prescriptions notice that such information is available 36 electronically and the address of its Internet website. 37 (2) In addition to the requirements of s. 465.025, a 38 pharmacist or her or his authorized employee must inform a 39 customer of a less expensive, generically equivalent drug 40 product for her or his prescription and as to whether the 41 customer’s cost-sharing obligation exceeds the retail price of 42 the prescription in the absence of prescription drug coverage. 43 Section 2. Section 465.1862, Florida Statutes, is repealed. 44 Section 3. Section 624.490, Florida Statutes, is created to 45 read: 46 624.490 Registration of pharmacy benefit managers.— 47 (1) As used in this section, the term “pharmacy benefit 48 manager” means a person or entity doing business in this state 49 which contracts to administer prescription drug benefits on 50 behalf of a health insurer or a health maintenance organization 51 to residents of this state. 52 (2) To conduct business in this state, a pharmacy benefit 53 manager must register with the office. To register, a pharmacy 54 benefit manager shall submit: 55 (a) A fee determined by the office. 56 (b) A copy of the registrant’s corporate charter, articles 57 of incorporation, or other charter document. 58 (c) A form established by the office containing the 59 identity, address, and taxpayer identification number, when 60 applicable, of: 61 1. The registrant. 62 2. The chief executive officer or a similarly titled person 63 responsible for the executive oversight of the registrant. 64 3. The chief financial officer or a similarly titled person 65 responsible for the financial oversight of the registrant. 66 4. Each person or entity responsible for the affairs of the 67 registrant, including, but not limited to, the day-to-day 68 operations of the registrant. 69 (3) The registrant shall report any change in information 70 required by subsection (2) to the office in writing within 60 71 days after the change occurs. 72 (4) Upon receipt of a completed registration form and the 73 registration fee, the office shall issue a registration 74 certificate. The certificate may be in paper or electronic form, 75 and shall clearly indicate the expiration date of the 76 registration. Registration certificates are nontransferable. 77 (5) A registration certificate is valid for 2 years from 78 its date of issue. The office shall set an initial registration 79 fee and a registration renewal fee, both of which shall be 80 nonrefundable. Total fees may not exceed the cost of 81 administering this section or $500, whichever is less. 82 (6) The office shall adopt rules necessary to implement 83 this section. 84 Section 4. Section 627.64741, Florida Statutes, is created 85 to read: 86 627.64741 Pharmacy benefit manager contracts.— 87 (1) As used in this section, the term: 88 (a) “Maximum allowable cost” means the per-unit amount that 89 a pharmacy benefit manager reimburses a pharmacist for a 90 prescription drug, excluding dispensing fees, prior to the 91 application of copayments, coinsurance, and other cost-sharing 92 charges, if any. 93 (b) “Pharmacy benefit manager” means a person or entity 94 doing business in this state which contracts to administer or 95 manage prescription drug benefits on behalf of a health insurer 96 to residents of this state. 97 (2) A contract between a health insurer and a pharmacy 98 benefit manager must require that the pharmacy benefit manager: 99 (a) Update maximum allowable cost pricing information at 100 least every 7 calendar days. 101 (b) Maintain a process that will, in a timely manner, 102 eliminate drugs from maximum allowable cost lists or modify drug 103 prices to remain consistent with changes in pricing data used in 104 formulating maximum allowable cost prices and product 105 availability. 106 (3) A contract between a health insurer and a pharmacy 107 benefit manager must prohibit the pharmacy benefit manager from 108 limiting a pharmacist’s ability to disclose whether the cost 109 sharing obligation exceeds the retail price for a covered 110 prescription drug, and the availability of a more affordable 111 alternative drug, pursuant 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 an insured to make a payment for a prescription drug 115 at the point of sale in an amount that exceeds the lesser of: 116 (a) The applicable cost-sharing amount; or 117 (b) The retail price of the drug in the absence of 118 prescription drug coverage. 119 (5) This section applies to contracts entered into or 120 renewed on or after July 1, 2018. 121 Section 5. Section 627.6572, Florida Statutes, is created 122 to read: 123 627.6572 Pharmacy benefit manager contracts.— 124 (1) As used in this section, the term: 125 (a) “Maximum allowable cost” means the per-unit amount that 126 a pharmacy benefit manager reimburses a pharmacist for a 127 prescription drug, excluding dispensing fees, prior to the 128 application of copayments, coinsurance, and any other cost 129 sharing charges. 130 (b) “Pharmacy benefit manager” means a person or entity 131 doing business in this state which contracts to administer or 132 manage prescription drug benefits on behalf of a health insurer 133 to residents of this state. 134 (2) A contract between a health insurer and a pharmacy 135 benefit manager must require that the pharmacy benefit manager: 136 (a) Update maximum allowable cost pricing information at 137 least every 7 calendar days. 138 (b) Maintain a process that will, in a timely manner, 139 eliminate drugs from maximum allowable cost lists or modify drug 140 prices to remain consistent with changes in pricing data used in 141 formulating maximum allowable cost prices and product 142 availability. 143 (3) A contract between a health insurer and a pharmacy 144 benefit manager must prohibit the pharmacy benefit manager from 145 limiting a pharmacist’s ability to disclose whether the cost 146 sharing obligation exceeds the retail price for a covered 147 prescription drug, and the availability of a more affordable 148 alternative drug, pursuant to s. 465.0244. 149 (4) A contract between a health insurer and a pharmacy 150 benefit manager must prohibit the pharmacy benefit manager from 151 requiring an insured to make a payment for a prescription drug 152 at the point of sale in an amount that exceeds the lesser of: 153 (a) The applicable cost-sharing amount; or 154 (b) The retail price of the drug in the absence of 155 prescription drug coverage. 156 (5) This section applies to contracts entered into or 157 renewed on or after July 1, 2018. 158 Section 6. Section 641.314, Florida Statutes, is created to 159 read: 160 641.314 Pharmacy benefit manager contracts.— 161 (1) As used in this section, the term: 162 (a) “Maximum allowable cost” means the per-unit amount that 163 a pharmacy benefit manager reimburses a pharmacist for a 164 prescription drug, excluding dispensing fees, prior to the 165 application of copayments, coinsurance, and any other cost 166 sharing charges. 167 (b) “Pharmacy benefit manager” means a person or entity 168 doing business in this state which contracts to administer or 169 manage prescription drug benefits on behalf of a health 170 maintenance organization to residents of this state. 171 (2) A contract between a health maintenance organization 172 and a pharmacy benefit manager must require that the pharmacy 173 benefit manager: 174 (a) Update maximum allowable cost pricing information at 175 least every 7 calendar days. 176 (b) Maintain a process that will, in a timely manner, 177 eliminate drugs from maximum allowable cost lists or modify drug 178 prices to remain consistent with changes in pricing data used in 179 formulating maximum allowable cost prices and product 180 availability. 181 (3) A contract between a health maintenance organization 182 and a pharmacy benefit manager must prohibit the pharmacy 183 benefit manager from limiting a pharmacist’s ability to disclose 184 whether the cost-sharing obligation exceeds the retail price for 185 a covered prescription drug, and the availability of a more 186 affordable alternative drug, pursuant to s. 465.0244. 187 (4) A contract between a health maintenance organization 188 and a pharmacy benefit manager must prohibit the pharmacy 189 benefit manager from requiring a subscriber to make a payment 190 for a prescription drug at the point of sale in an amount that 191 exceeds the lesser of: 192 (a) The applicable cost-sharing amount; or 193 (b) The retail price of the drug in the absence of 194 prescription drug coverage. 195 (5) This section applies to contracts entered into or 196 renewed on or after July 1, 2018. 197 Section 7. This act shall take effect July 1, 2018.