Florida Senate - 2021                                    SB 1306
       
       
        
       By Senator Rodriguez
       
       
       
       
       
       39-01269-21                                           20211306__
    1                        A bill to be entitled                      
    2         An act relating to Medicaid pharmacy benefit savings;
    3         creating s. 409.93, F.S.; providing a short title;
    4         providing legislative findings; requiring the Agency
    5         for Health Care Administration to select a single
    6         pharmacy benefit administrator through a competitive
    7         procurement process to administer all pharmacy
    8         benefits for Medicaid recipients enrolled in managed
    9         care plans; requiring the agency to complete the
   10         procurement process and select the pharmacy benefit
   11         administrator by a specified date; prohibiting managed
   12         care organizations from providing pharmacy benefits
   13         for their enrolled members; requiring the agency to
   14         make certain considerations during the procurement
   15         process; providing contract requirements; requiring
   16         the agency to calculate an amount equal to a specified
   17         percentage of each managed care organization’s net
   18         underwriting gain for a certain contract year;
   19         requiring the agency to reduce a managed care
   20         organization’s contract term payment by such amount to
   21         be used for specified purposes; providing an effective
   22         date.
   23          
   24  Be It Enacted by the Legislature of the State of Florida:
   25  
   26         Section 1. Section 409.93, Florida Statutes, is created to
   27  read:
   28         409.93 Medicaid Pharmacy Benefit Savings Optimization Act.—
   29         (1) This section may be cited as the “Medicaid Pharmacy
   30  Benefit Savings Optimization Act.”
   31         (2) The Legislature finds that:
   32         (a) The Agency for Health Care Administration administers
   33  Medicaid benefits for the state’s low-income beneficiaries and
   34  aged and disabled persons as well as children’s health insurance
   35  programs for uninsured children in low-income families.
   36         (b) The agency provides certain Medicaid benefits to the
   37  residents of this state directly through its fee-for-service
   38  program or indirectly through managed care organizations.
   39         (c) Pharmacy benefits for Medicaid patients in this state
   40  are generally provided using managed care organizations.
   41         (d) Despite efforts to reduce the costs of prescription
   42  drugs, the state Medicaid program continues to experience
   43  substantial increases in prescription drug costs each year.
   44         (e) Several states have passed legislation removing
   45  prescription drug benefits from their Medicaid managed care
   46  delivery systems and providing all pharmacy benefits through
   47  their existing fee-for-service programs or using a single
   48  pharmacy benefit administrator, resulting in savings of hundreds
   49  of millions of dollars for those states.
   50         (f) Moving pharmacy benefits from the Medicaid managed care
   51  delivery system and providing those benefits through a single
   52  pharmacy benefit administrator using the state’s existing
   53  Medicaid fee-for-service program could result in potentially
   54  significant savings for the state.
   55         (3)(a) The agency shall select a single pharmacy benefit
   56  administrator through a competitive procurement process to
   57  administer all pharmacy benefits for Medicaid recipients
   58  enrolled in managed care plans.
   59         (b) By October 1, 2021, the agency shall complete the
   60  procurement process and select a single pharmacy benefit
   61  administrator. Upon such selection, managed care organizations
   62  may no longer provide pharmacy benefits for their enrolled
   63  members. As part of the procurement process, the agency shall
   64  consider pricing, quality, accessibility, and any potential
   65  conflicts of interest the pharmacy benefit administrator may
   66  have with the agency, a managed care plan, or a pharmacy
   67  participating in the state’s Medicaid program. The contract with
   68  the pharmacy benefit administrator must:
   69         1. Establish the pharmacy benefit administrator’s fiduciary
   70  duty to the state.
   71         2. Require the use of pass-through pricing by the pharmacy
   72  benefit administrator.
   73         3. Require the pharmacy benefit administrator to use the
   74  preferred drug list, reimbursement methodologies, and dispensing
   75  fees established by the agency for its existing Medicaid fee
   76  for-service program.
   77         4. Prohibit the pharmacy benefit administrator from
   78  requiring a Medicaid recipient to use a mail order pharmacy.
   79         5. Prohibit the pharmacy benefit administrator from
   80  excluding a pharmacy that is willing to accept reasonable terms
   81  and conditions established by the pharmacy benefit administrator
   82  to participate in the plan network.
   83         (4) The agency shall calculate an amount equal to 20
   84  percent of each managed care organization’s net underwriting
   85  gain for the July 1, 2020, through June 30, 2021, contract year,
   86  as determined by the agency’s Medicaid actuary. The agency shall
   87  reduce each managed care organization’s subsequent contract term
   88  payment by such amount and use this amount to provide pharmacy
   89  benefits for managed care organization members, including any
   90  costs incurred to implement this act.
   91         Section 2. This act shall take effect upon becoming a law.