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2022 Florida Statutes (including 2022C, 2022D, 2022A, and 2023B)

Title XXXVII INSURANCE
Chapter 641 HEALTH CARE SERVICE PROGRAMS Entire Chapter
SECTION 314
Pharmacy benefit manager contracts.
F.S. 641.314
641.314 Pharmacy benefit manager contracts.—
(1) As used in this section, the term:
(a) “Maximum allowable cost” means the per-unit amount that a pharmacy benefit manager reimburses a pharmacist for a prescription drug, excluding dispensing fees, prior to the application of copayments, coinsurance, and other cost-sharing charges, if any.
(b) “Pharmacy benefit manager” means a person or entity doing business in this state which contracts to administer or manage prescription drug benefits on behalf of a health maintenance organization to residents of this state.
(2) A contract between a health maintenance organization and a pharmacy benefit manager must require that the pharmacy benefit manager:
(a) Update maximum allowable cost pricing information at least every 7 calendar days.
(b) Maintain a process that will, in a timely manner, eliminate drugs from maximum allowable cost lists or modify drug prices to remain consistent with changes in pricing data used in formulating maximum allowable cost prices and product availability.
(3) A contract between a health maintenance organization and a pharmacy benefit manager must prohibit the pharmacy benefit manager from limiting a pharmacist’s ability to disclose whether the cost-sharing obligation exceeds the retail price for a covered prescription drug, and the availability of a more affordable alternative drug, pursuant to s. 465.0244.
(4) A contract between a health maintenance organization and a pharmacy benefit manager must prohibit the pharmacy benefit manager from requiring a subscriber to make a payment for a prescription drug at the point of sale in an amount that exceeds the lesser of:
(a) The applicable cost-sharing amount; or
(b) The retail price of the drug in the absence of prescription drug coverage.
(5) This section applies to contracts entered into or renewed on or after July 1, 2018.
History.—s. 6, ch. 2018-91.