HB 947 2022
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hb0947-00
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to patient -specific prescription drug 2
coverage transparency; creating s. 456.45, F.S.; 3
providing legislative intent and definitions; 4
providing that patients are entitled to receive, upon 5
request, specified information from a prescribing or 6
ordering health care provider; specifying information 7
that certain insurers must provide to health care 8
providers and requirements for the provision of such 9
information; authorizing health care providers to 10
designate a third party to facilitate the exchange of 11
such information; authorizing insurers to enter into 12
agreements with designated third parties for a 13
specified purpose; providing limitations on such 14
agreements; providing an effective date. 15
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Be It Enacted by the Legislature of the State of Florida: 17
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Section 1. Section 456.45, Florida Statutes, is created to 19
read: 20
456.45 Informed prescribing decisions; patient -specific 21
prescription drug coverage tr ansparency.— 22
(1) It is the intent of the Legislature to enable health 23
care providers to make fully informed prescribing decisions, 24
increase patient adherence to medication, and promote 25
HB 947 2022
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
transparency of health care and prescription drug costs to the 26
patient by facilitating real -time conversations between patients 27
and health care providers about patient -specific information 28
regarding prescription drug benefits, coverage, and costs. 29
(2) As used in this section, the term: 30
(a) "Health care provider" means a health care 31
practitioner authorized by law to prescribe or order 32
prescription drugs. 33
(b) "Insurer" means a health insurer licensed under 34
chapter 627, a health maintenance organization licensed under 35
chapter 641, or an entity acting on behalf of a health insurer 36
or health maintenance organization. 37
(c) "Patient-specific information regarding prescription 38
drug benefits, coverage, and costs" means, but is not limited 39
to, applicable drug formulary and benefit data, coverage for the 40
prescribed or ordered pre scription drug and clinically 41
appropriate alternatives, patient -specific cost-sharing 42
information, and other applicable eligibility and benefit 43
information specific to the patient. 44
(d) "Point of care" means the time at which a health care 45
provider, or his or her agent, prescribes or orders a 46
prescription drug. 47
(e) "Prescribing decision" means a health care provider's, 48
or his or her agent's, decision to prescribe or order any 49
prescription drug. 50
HB 947 2022
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
(3) A patient may request at the point of care, and the 51
prescribing or ordering health care provider must provide to the 52
patient upon request, the patient's real -time, patient-specific 53
information regarding prescription drug benefits, coverage, and 54
costs in order to facilitate a discussion of benefit, coverage, 55
and cost options and enable the health care provider to make 56
fully informed prescribing decisions. The health care provider 57
may offer the information regardless of whether the patient 58
requests it and the patient may refuse the information. 59
(4) To facilitate the exchange of information between 60
patients and health care providers under this section, insurers 61
must provide to health care providers, at a minimum, all of the 62
following information: 63
(a) Patient-specific prescription drug benefits, 64
including, but not limited to, any applicable drug formulary and 65
benefit data, coverage for the prescribed drug, and any 66
clinically appropriate alternatives. 67
(b) Patient-specific cost-sharing information. The 68
information must include any variances in patient cost-sharing 69
obligations based on which pharmacy dispenses the prescribed 70
drug or its alternatives and the patient's benefits and 71
limitations, such as deductibles, out -of-pocket maximums, or 72
other similar measures. 73
(c) Any applicable utilization manageme nt requirements, 74
such as prior authorization requirements. 75
HB 947 2022
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
(5) Insurers shall make the information required under 76
this section available to the requesting health care provider, 77
or a third party designated by the health care provider, through 78
a standard electronic data exchange or an application 79
programming interface that uses standards accredited by the 80
American National Standards Institute. The interface must be 81
used solely for the purpose of integrating information required 82
by this section into a health care provider's workflow or 83
electronic health recordkeeping system. An insurer may enter 84
into an agreement with a third party designated by a health care 85
provider to define the scope of, and access to, such 86
information. However, the agreement may not proh ibit the third 87
party from displaying patient -specific information regarding 88
prescription drug benefits, coverage, and costs which reflects 89
other options, such as the out -of-pocket price, any patient 90
assistance and support programs, and the cost available a t the 91
patient's pharmacy of choice. 92
Section 2. This act shall take effect January 1, 2023. 93