Florida Senate - 2018 SB 360 By Senator Mayfield 17-00425-18 2018360__ 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.; prohibiting specified changes to 5 certain insurance policy prescription drug 6 formularies, except under certain circumstances; 7 providing construction and applicability; amending s. 8 627.6699, F.S.; requiring small employer carriers to 9 limit specified changes to prescription drug 10 formularies under certain health benefit plans; 11 amending s. 641.31, F.S.; prohibiting certain health 12 maintenance organizations from making specified 13 changes to health maintenance contract prescription 14 drug formularies, except under certain circumstances; 15 providing construction and applicability; providing a 16 declaration of important state interest; providing an 17 effective date. 18 19 Be It Enacted by the Legislature of the State of Florida: 20 21 Section 1. Section 627.42393, Florida Statutes, is created 22 to read: 23 627.42393 Insurance policies; limiting changes to 24 prescription drug formularies.— 25 (1) Other than at the time of coverage renewal, an 26 individual or group insurance policy that is delivered, issued 27 for delivery, renewed, amended, or continued in this state and 28 that provides medical, major medical, or similar comprehensive 29 coverage may not: 30 (a) Remove a covered prescription drug from its list of 31 covered drugs during the policy year unless the United States 32 Food and Drug Administration has issued a statement about the 33 drug which calls into question the clinical safety of the drug, 34 or the manufacturer of the drug has notified the United States 35 Food and Drug Administration of a manufacturing discontinuance 36 or potential discontinuance of the drug as required by s. 506C 37 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c. 38 (b) Reclassify a drug to a more restrictive drug tier or 39 increase the amount that an insured must pay for a copayment, 40 coinsurance, or deductible for prescription drug benefits, or 41 reclassify a drug to a higher cost-sharing tier during the 42 policy year. 43 (2) This section does not prohibit the addition of 44 prescription drugs to the list of drugs covered under the policy 45 during the policy year. 46 (3) This section does not apply to a grandfathered health 47 plan as defined in s. 627.402 or to benefits set forth in s. 48 627.6513(1)-(14). 49 (4) This section does not alter or amend s. 465.025, which 50 provides conditions under which a pharmacist may substitute a 51 generically equivalent drug product for a brand name drug 52 product. 53 (5) This section does not alter or amend s. 465.0252, which 54 provides conditions under which a pharmacist may dispense a 55 substitute biological product for the prescribed biological 56 product. 57 Section 2. Paragraph (e) of subsection (5) of section 58 627.6699, Florida Statutes, is amended to read: 59 627.6699 Employee Health Care Access Act.— 60 (5) AVAILABILITY OF COVERAGE.— 61 (e) All health benefit plans issued under this section must 62 comply with the following conditions: 63 1. For employers who have fewer than two employees, a late 64 enrollee may be excluded from coverage for no longer than 24 65 months if he or she was not covered by creditable coverage 66 continually to a date not more than 63 days before the effective 67 date of his or her new coverage. 68 2. Any requirement used by a small employer carrier in 69 determining whether to provide coverage to a small employer 70 group, including requirements for minimum participation of 71 eligible employees and minimum employer contributions, must be 72 applied uniformly among all small employer groups having the 73 same number of eligible employees applying for coverage or 74 receiving coverage from the small employer carrier, except that 75 a small employer carrier that participates in, administers, or 76 issues health benefits pursuant to s. 381.0406 which do not 77 include a preexisting condition exclusion may require as a 78 condition of offering such benefits that the employer has had no 79 health insurance coverage for its employees for a period of at 80 least 6 months. A small employer carrier may vary application of 81 minimum participation requirements and minimum employer 82 contribution requirements only by the size of the small employer 83 group. 84 3. In applying minimum participation requirements with 85 respect to a small employer, a small employer carrier shall not 86 consider as an eligible employee employees or dependents who 87 have qualifying existing coverage in an employer-based group 88 insurance plan or an ERISA qualified self-insurance plan in 89 determining whether the applicable percentage of participation 90 is met. However, a small employer carrier may count eligible 91 employees and dependents who have coverage under another health 92 plan that is sponsored by that employer. 93 4. A small employer carrier shall not increase any 94 requirement for minimum employee participation or any 95 requirement for minimum employer contribution applicable to a 96 small employer at any time after the small employer has been 97 accepted for coverage, unless the employer size has changed, in 98 which case the small employer carrier may apply the requirements 99 that are applicable to the new group size. 100 5. If a small employer carrier offers coverage to a small 101 employer, it must offer coverage to all the small employer’s 102 eligible employees and their dependents. A small employer 103 carrier may not offer coverage limited to certain persons in a 104 group or to part of a group, except with respect to late 105 enrollees. 106 6. A small employer carrier may not modify any health 107 benefit plan issued to a small employer with respect to a small 108 employer or any eligible employee or dependent through riders, 109 endorsements, or otherwise to restrict or exclude coverage for 110 certain diseases or medical conditions otherwise covered by the 111 health benefit plan. 112 7. An initial enrollment period of at least 30 days must be 113 provided. An annual 30-day open enrollment period must be 114 offered to each small employer’s eligible employees and their 115 dependents. A small employer carrier must provide special 116 enrollment periods as required by s. 627.65615. 117 8. A small employer carrier must limit changes to 118 prescription drug formularies as required by s. 627.42393. 119 Section 3. Subsection (36) of section 641.31, Florida 120 Statutes, is amended to read: 121 641.31 Health maintenance contracts.— 122 (36) A health maintenance organization may increase the 123 copayment for any benefit, or delete, amend, or limit any of the 124 benefits to which a subscriber is entitled under the group 125 contract only, upon written notice to the contract holder at 126 least 45 days in advance of the time of coverage renewal. The 127 health maintenance organization may amend the contract with the 128 contract holder, with such amendment to be effective immediately 129 at the time of coverage renewal. The written notice to the 130 contract holder must
shallspecifically identify any deletions, 131 amendments, or limitations to any of the benefits provided in 132 the group contract during the current contract period which will 133 be included in the group contract upon renewal. This subsection 134 does not apply to any increases in benefits. The 45-day notice 135 requirement does shallnot apply if benefits are amended, 136 deleted, or limited at the request of the contract holder. 137 (a) Other than at the time of coverage renewal, a health 138 maintenance organization that provides medical, major medical, 139 or similar comprehensive coverage may not: 140 1. Remove a covered prescription drug from its list of 141 covered drugs during the contract year unless the United States 142 Food and Drug Administration has issued a statement about the 143 drug which calls into question the clinical safety of the drug, 144 or the manufacturer of the drug has notified the United States 145 Food and Drug Administration of a manufacturing discontinuance 146 or potential discontinuance of the drug as required by s. 506C 147 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c. 148 2. Reclassify a drug to a more restrictive drug tier or 149 increase the amount that an insured must pay for a copayment, 150 coinsurance, or deductible for prescription drug benefits, or 151 reclassify a drug to a higher cost-sharing tier during the 152 contract year. 153 (b) This subsection does not: 154 1. Prohibit the addition of prescription drugs to the list 155 of drugs covered during the contract year. 156 2. Apply to a grandfathered health plan as defined in s. 157 627.402 or to benefits set forth in s. 627.6513(1)-(14). 158 3. Alter or amend s. 465.025, which provides conditions 159 under which a pharmacist may substitute a generically equivalent 160 drug product for a brand name drug product. 161 4. Alter or amend s. 465.0252, which provides conditions 162 under which a pharmacist may dispense a substitute biological 163 product for the prescribed biological product. 164 Section 4. The Legislature finds that this act fulfills an 165 important state interest. 166 Section 5. This act shall take effect January 1, 2019.