Florida Senate - 2022                          SENATOR AMENDMENT
       Bill No. SB 730
       
       
       
       
       
       
                                Ì601886JÎ601886                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                  Floor: WD            .                                
             03/08/2022 11:55 AM       .                                
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       Senator Farmer moved the following:
       
    1         Senate Amendment 
    2  
    3         Delete lines 36 - 108
    4  and insert:
    5         (a)The prescription drug is a non-opioid based analgesic
    6  drug product, and the insurer’s step-therapy protocol would
    7  otherwise require the insured to be prescribed an opioid
    8  analgesic drug product or an abuse-deterrent opioid analgesic
    9  drug product; or
   10         (b)1.(a) The insured has previously been approved to
   11  receive the prescription drug through the completion of a step
   12  therapy protocol required by a separate health coverage plan;
   13  and
   14         2.(b) The insured provides documentation originating from
   15  the health coverage plan that approved the prescription drug as
   16  described in subparagraph 1. paragraph (a) indicating that the
   17  health coverage plan paid for the drug on the insured’s behalf
   18  during the 90 days immediately before the request.
   19         (1)(2) As used in this section, the term:
   20         (a) “Health coverage plan” means any of the following which
   21  is currently or was previously providing major medical or
   22  similar comprehensive coverage or benefits to the insured:
   23         1.(a) A health insurer or health maintenance organization.
   24         2.(b) A plan established or maintained by an individual
   25  employer as provided by the Employee Retirement Income Security
   26  Act of 1974, Pub. L. No. 93-406.
   27         3.(c) A multiple-employer welfare arrangement as defined in
   28  s. 624.437.
   29         4.(d) A governmental entity providing a plan of self
   30  insurance.
   31         (b)“Protocol exemption” means a determination by a health
   32  insurer to authorize the use of another prescription drug,
   33  medical procedure, or course of treatment prescribed or
   34  recommended by the treating health care provider for the
   35  insured’s condition rather than the one specified by the health
   36  insurer’s step-therapy protocol.
   37         (c)“Step-therapy protocol” means a written protocol that
   38  specifies the order in which certain prescription drugs, medical
   39  procedures, or courses of treatment must be used to treat an
   40  insured’s condition.
   41         (3)(a)A health insurer shall publish on its website and
   42  provide to an insured in writing a procedure for the insured and
   43  his or her health care provider to request a protocol exemption
   44  or an appeal of the health insurer’s denial of a protocol
   45  exemption request. The procedure must include, at a minimum:
   46         1.The manner in which the insured or health care provider
   47  may request a protocol exemption, including a form to request
   48  the protocol exemption.
   49         2.The manner and timeframe in which the health insurer
   50  must authorize or deny a protocol exemption request, including
   51  the requirement that such response must occur within a
   52  reasonable time.
   53         3.The manner and timeframe in which the insured or health
   54  care provider may appeal the health insurer’s denial of a
   55  protocol exemption request.
   56         (b)An authorization of a protocol exemption request must
   57  specify the approved prescription drug, medical procedure, or
   58  course of treatment. A denial of a protocol exemption request
   59  must include a written explanation of the reason for the denial,
   60  the clinical rationale that supports the denial, and the
   61  procedure for appealing the health insurer’s denial.
   62         (c)A health insurer may request relevant medical records
   63  in support of a protocol exemption request.
   64         (4)(3) This section does not require a health insurer to
   65  add a drug to its prescription drug formulary or to cover a
   66  prescription drug that the insurer does not otherwise cover.
   67         Section 2. Subsection (46) of section 641.31, Florida
   68  Statutes, is amended to read:
   69         641.31 Health maintenance contracts.—
   70         (46)(b)(46)(a)In addition to the protocol exemptions
   71  granted under paragraph (c), a health maintenance organization
   72  issuing major medical coverage through an individual or group
   73  contract may not require a step-therapy protocol under the
   74  contract for a covered prescription drug requested by a
   75  subscriber if:
   76         1.The prescription drug is a non-opioid based analgesic
   77  drug product, and the health maintenance organization’s step
   78  therapy protocol would otherwise require the subscriber to be
   79  prescribed an opioid analgesic drug product or an abuse
   80  deterrent opioid analgesic drug product; or
   81         2.a.1. The subscriber has previously been approved to
   82  receive the prescription drug through the completion of a step
   83  therapy protocol required by a separate health coverage plan;
   84  and
   85         b.2. The subscriber provides documentation originating from
   86  the health coverage plan that approved the prescription drug as
   87  described in sub-subparagraph a. subparagraph 1. indicating that
   88  the health coverage plan paid for the drug on the subscriber’s
   89  behalf during the 90 days immediately before the request.