Florida Senate - 2022 SB 1290
By Senator Gruters
23-00781B-22 20221290__
1 A bill to be entitled
2 An act relating to patient-specific drug coverage
3 transparency; creating s. 456.45, F.S.; providing
4 legislative intent; defining terms; authorizing
5 patients to request, and requiring ordering or
6 prescribing health care providers to provide, real
7 time, patient-specific information regarding
8 prescription drug benefits, coverage, and costs for a
9 specified purpose; authorizing health care providers
10 to provide such information to patients regardless of
11 whether a request is made; authorizing patients to
12 refuse such information; requiring insurers to provide
13 specified information to health care providers;
14 specifying requirements for the provision of such
15 information; authorizing insurers to enter into
16 agreements with third parties designated by health
17 care providers to facilitate the exchange of such
18 information; providing limitations on such agreements;
19 providing an effective date.
20
21 Be It Enacted by the Legislature of the State of Florida:
22
23 Section 1. Section 456.45, Florida Statutes, is created to
24 read:
25 456.45 Informed prescribing decisions; patient-specific
26 prescription drug coverage transparency.—
27 (1) It is the intent of the Legislature to enable health
28 care providers to make fully informed prescribing decisions,
29 increase patient adherence to medication, and promote
30 transparency of health care and prescription drug costs to the
31 patient by facilitating real-time conversations between patients
32 and health care providers about patient-specific information
33 regarding prescription drug benefits, coverage, and costs.
34 (2) As used in this section, the term:
35 (a) “Health care provider” means a health care practitioner
36 authorized by law to prescribe or order prescription drugs.
37 (b) “Insurer” means a health insurer licensed under chapter
38 627 or a health maintenance organization licensed under chapter
39 641 or any entity acting on behalf of a health insurer or health
40 maintenance organization.
41 (c) “Patient-specific information regarding prescription
42 drug benefits, coverage, and costs” means, but is not limited
43 to, applicable drug formulary and benefit data, coverage for the
44 prescribed or ordered prescription drug and clinically
45 appropriate alternatives, and other applicable eligibility,
46 benefit, and cost-sharing information specific to the patient.
47 (d) “Point of care” means the time at which a health care
48 provider, or his or her agent, prescribes or orders any
49 prescription drug.
50 (e) “Prescribing decision” means a health care provider’s,
51 or his or her agent’s, decision to prescribe or order any
52 prescription drug.
53 (3) At the point of care, a patient may request, and the
54 prescribing or ordering health care provider must provide upon
55 such request, the patient’s real-time, patient-specific
56 information regarding prescription drug benefits, coverage, and
57 costs in order to facilitate a discussion of benefit, coverage,
58 and cost options and to enable the health care provider to make
59 a fully informed prescribing decision. A health care provider
60 may offer this information regardless of whether the patient
61 requests it, but the patient has the right to refuse the
62 information.
63 (4) To facilitate the exchange of information between
64 patients and health care providers under this section, insurers
65 shall provide to health care providers, at a minimum, all of the
66 following information:
67 (a) Patient-specific prescription drug benefits, including,
68 but not limited to, any applicable drug formulary and benefit
69 data, coverage for the prescribed drug, and clinically
70 appropriate alternatives.
71 (b) Patient-specific cost-sharing information. The
72 information must include any variances in patient cost-sharing
73 obligations based on which pharmacy dispenses the prescribed
74 drug or its alternatives and the patient’s benefits and
75 limitations, such as out-of-pocket maximums, deductibles, and
76 other similar measures.
77 (c) Any applicable utilization management requirements,
78 such as prior authorization requirements.
79 (5) Insurers shall make the information required under this
80 section available to the requesting health care provider, or a
81 third party designated by the health care provider, through a
82 standard electronic data exchange or an application programming
83 interface that uses standards accredited by the American
84 National Standards Institute. The interface must be used solely
85 for the purpose of integrating information required by this
86 section into a health care provider’s workflow or electronic
87 health recordkeeping system. An insurer may enter into an
88 agreement with a third party designated by a health care
89 provider to define the scope of, and access to, such
90 information. However, the agreement may not prohibit the third
91 party from displaying patient-specific information regarding
92 prescription drug benefits, coverage, and costs which reflects
93 other options, such as the out-of-pocket price, any patient
94 assistance and support programs, and the cost available at the
95 patient’s pharmacy of choice.
96 Section 2. This act shall take effect January 1, 2023.