Florida Senate - 2023                                     SB 420
       
       
        
       By Senator Wright
       
       
       
       
       
       8-00270-23                                             2023420__
    1                        A bill to be entitled                      
    2         An act relating to pharmacy benefit managers; amending
    3         s. 624.3161, F.S.; requiring the Office of Insurance
    4         Regulation to conduct market conduct examinations of
    5         pharmacy benefit managers as often as the office deems
    6         necessary; amending s. 624.490, F.S.; defining the
    7         terms “affiliate” and “spread pricing”; authorizing
    8         the office to take certain disciplinary actions
    9         against a pharmacy benefit manager for specified acts;
   10         providing an effective date.
   11          
   12  Be It Enacted by the Legislature of the State of Florida:
   13  
   14         Section 1. Subsections (1) and (3) of section 624.3161,
   15  Florida Statutes, are amended to read:
   16         624.3161 Market conduct examinations.—
   17         (1) As often as it deems necessary, the office shall
   18  examine each pharmacy benefit manager as defined in s.
   19  624.490(1); each licensed rating organization;, each advisory
   20  organization;, each group, association, carrier, as defined in
   21  s. 440.02, or other organization of insurers which engages in
   22  joint underwriting or joint reinsurance;, and each authorized
   23  insurer transacting in this state any class of insurance to
   24  which the provisions of chapter 627 are applicable. The
   25  examination shall be for the purpose of ascertaining compliance
   26  by the person examined with the applicable provisions of
   27  chapters 440, 624, 626, 627, and 635.
   28         (3) The examination may be conducted by an independent
   29  professional examiner under contract to the office, in which
   30  case payment shall be made directly to the contracted examiner
   31  by the insurer or person examined in accordance with the rates
   32  and terms agreed to by the office and the examiner.
   33         Section 2. Present subsection (7) of section 624.490,
   34  Florida Statutes, is redesignated as subsection (8), a new
   35  subsection (7) is added to that section, and subsection (1) of
   36  that section is amended, to read:
   37         624.490 Registration of pharmacy benefit managers.—
   38         (1) As used in this section, the term:
   39         (a) “Affiliate” means, with respect to a pharmacy benefit
   40  manager, a pharmacy:
   41         1. In which the pharmacy benefit manager, directly or
   42  indirectly, has an investment or financial or ownership
   43  interest;
   44         2. That, directly or indirectly, has an investment or
   45  financial or ownership interest in the pharmacy benefit manager;
   46  or
   47         3. That is under common ownership, directly or indirectly,
   48  with the pharmacy benefit manager.
   49         (b) “Pharmacy benefit manager” means a person or entity
   50  doing business in this state which contracts to administer
   51  prescription drug benefits on behalf of a health insurer or a
   52  health maintenance organization to residents of this state.
   53         (c) “Spread pricing” means any technique by which a
   54  pharmacy benefit manager charges or claims an amount from a
   55  health insurer or health maintenance organization for pharmacy
   56  or pharmacist services, including payment for a prescription
   57  drug, which amount is different than the amount the pharmacy
   58  benefit manager pays to the pharmacy or pharmacist that provided
   59  the services.
   60         (7) The office may suspend or revoke a pharmacy benefit
   61  manager’s registration or impose a fine if it finds the pharmacy
   62  benefit manager committed any of the following:
   63         (a) Breached its fiduciary duty to the health insurer or
   64  health maintenance organization.
   65         (b) Used spread pricing.
   66         (c) Reduced payment for pharmacy or pharmacist services,
   67  directly or indirectly, by creating, imposing, or establishing
   68  direct or indirect remuneration fees; generic effective rates,
   69  dispensing effective rates, brand effective rates, or any other
   70  effective rates; in-network fees, performance fees,
   71  preadjudication fees, or postadjudication fees; or any other
   72  mechanism that reduces, or aggregately reduces, payment for
   73  pharmacy or pharmacist services.
   74         (d) Required or influenced an insured or enrollee to use an
   75  affiliate of the pharmacy benefit manager.
   76         (e) Required or influenced an insured or enrollee to use a
   77  mail-order pharmacy.
   78         (f) Excluded a pharmacy that was willing to accept the
   79  plan’s terms and reimbursement and that met the plan’s
   80  credentialing requirements and quality standards from
   81  participating in the plan.
   82         (g) Violated s. 624.491, s. 627.6131, s. 627.64741, s.
   83  627.6572, s. 641.314, or s. 641.3155.
   84         Section 3. This act shall take effect July 1, 2023.