HB 1063 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
A bill to be entitled 1
An act relating to health insurance cost sharing; 2
creating s. 627.6383, F.S.; defining the term "cost -3
sharing requirement"; requiring specified individual 4
health insurers and their pharmacy benefit managers to 5
apply payments by or on behalf of insureds toward the 6
total contributions of the insureds' cost -sharing 7
requirements; providing applicability; amending s. 8
627.6385, F.S.; requiring specified individual health 9
insurers to disclose on their websites and in their 10
policies their applications of payments by or on 11
behalf of policyholders toward the policyholders' 12
total contributions to cost -sharing requirements; 13
providing applicability; amending ss. 627.64741 , 14
627.6572, and 641.314, F.S.; requiring pharmacy 15
benefit managers to apply payments by or on behalf of 16
insureds and subscribers toward the insureds' and 17
subscribers' total contributions to cost -sharing 18
requirements; providing applicability; providing 19
disclosure requirements; creating s. 627.65715, F.S., 20
and amending s. 641.31, F.S.; defining the term "cost -21
sharing requirement"; requiring specified group health 22
insurers and health maintenance organizations and 23
their pharmacy benefit managers to apply paymen ts by 24
or on behalf of insureds and subscribers toward the 25
HB 1063 2022
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total contributions of the insureds' and subscribers' 26
cost-sharing requirements, respectively; providing 27
disclosure requirements; providing applicability; 28
amending s. 627.6699, F.S.; providing requi rements for 29
small employer carriers; amending s. 409.967, F.S.; 30
conforming a cross-reference; amending s. 641.185, 31
F.S.; conforming a provision to changes made by the 32
act; providing a declaration of important state 33
interest; providing an effective date. 34
35
Be It Enacted by the Legislature of the State of Florida: 36
37
Section 1. Section 627.6383, Florida Statutes, is created 38
to read: 39
627.6383 Cost-sharing requirements. — 40
(1) As used in this section, the term "cost -sharing 41
requirement" means a dollar li mit, deductible, copayment, 42
coinsurance, or any other out -of-pocket expense imposed on an 43
insured, including, but not limited to, the annual limitation on 44
cost sharing subject to 42 U.S.C. s. 18022. 45
(2)(a) Each health insurer issuing, delivering, or 46
renewing a policy in this state which provides prescription drug 47
coverage or each pharmacy benefit manager on behalf of such 48
health insurer must apply any amount paid by an insured or by 49
another person on behalf of the insured toward the insured's 50
HB 1063 2022
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total contribution to any cost-sharing requirement. 51
(b) The amount paid by or on behalf of the insured which 52
is applied toward the insured's total contribution to any cost -53
sharing requirement under paragraph (a) includes, but is not 54
limited to, any payment with, or any discount through, financial 55
assistance, a manufacturer copay card, a product voucher, or any 56
other reduction in out -of-pocket expenses made by or on behalf 57
of the insured for a prescription drug. 58
(3) This section applies to any health insurance polic y 59
issued, delivered, or renewed in this state on or after January 60
1, 2023. 61
Section 2. Subsections (2) and (3) of section 627.6385, 62
Florida Statutes, are renumbered as subsections (3) and (4), 63
respectively, present subsection (2) is amended, and a new 64
subsection (2) is added to that section, to read: 65
627.6385 Disclosures to policyholders; calculations of 66
cost sharing.— 67
(2) Each health insurer issuing, delivering, or renewing a 68
policy in this state which provides prescription drug coverage, 69
regardless of whether the prescription drug benefits are 70
administered or managed by the health insurer or by a pharmacy 71
benefit manager on behalf of the health insurer, shall disclose 72
on its website that any amount paid by a policyholder or by 73
another person on beha lf of the policyholder shall be applied 74
toward the policyholder's total contribution to any cost -sharing 75
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requirement pursuant to s. 627.6383. This subsection applies to 76
any policy issued, delivered, or renewed in this state on or 77
after January 1, 2023. 78
(3)(2) Each health insurer shall include in every policy 79
delivered or issued for delivery to any person in the state or 80
in materials provided as required by s. 627.64725 notice that 81
the information required by this section is available 82
electronically and th e address of the website where the 83
information can be accessed. In addition, each health insurer 84
issuing, delivering, or renewing a policy in this state which 85
provides prescription drug coverage, regardless of whether the 86
prescription drug benefits are adm inistered or managed by the 87
health insurer or by a pharmacy benefit manager on behalf of the 88
health insurer, shall include in every policy that is issued, 89
delivered, or renewed to any person in this state on or after 90
January 1, 2023, the disclosure that an y amount paid by a 91
policyholder or by another person on behalf of the policyholder 92
shall be applied toward the policyholder's total contribution to 93
any cost-sharing requirement pursuant to s. 627.6383. 94
Section 3. Paragraph (c) is added to subsection (2 ) of 95
section 627.64741, Florida Statutes, to read: 96
627.64741 Pharmacy benefit manager contracts. — 97
(2) A contract between a health insurer and a pharmacy 98
benefit manager must require that the pharmacy benefit manager: 99
(c)1. Apply any amount paid by an insured or by another 100
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person on behalf of the insured toward the insured's total 101
contribution to any cost -sharing requirement pursuant to s. 102
627.6383. This subparagraph applies to any insured whose 103
insurance policy is iss ued, delivered, or renewed in this state 104
on or after January 1, 2023. 105
2. Disclose to every insured whose insurance policy is 106
issued, delivered, or renewed in this state on or after January 107
1, 2023, that the pharmacy benefit manager shall apply any 108
amount paid by the insured or by another person on behalf of the 109
insured toward the insured's total contribution to any cost -110
sharing requirement pursuant to s. 627.6383. 111
Section 4. Section 627.65715, Florida Statutes, is created 112
to read: 113
627.65715 Cost-sharing requirements.— 114
(1) As used in this section, the term "cost -sharing 115
requirement" means a dollar limit, deductible, copayment, 116
coinsurance, or any other out -of-pocket expense imposed on an 117
insured, including, but not limited to, the annual limitation on 118
cost sharing subject to 42 U.S.C. s. 18022. 119
(2)(a) Each insurer issuing, delivering, or renewing a 120
policy in this state which provides prescription drug coverage 121
or each pharmacy benefit manager on behalf of such insurer must 122
apply any amount paid by an insured or by another person on 123
behalf of the insured toward the insured's total contribution to 124
any cost-sharing requirement. 125
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(b) The amount paid by or on behalf of the insured which 126
is applied toward the insured's total contribution to any cost -127
sharing requirement under paragraph (a) includes, but is not 128
limited to, any payment with, or any discount through, financial 129
assistance, a manufacturer copay card, a product voucher, or any 130
other reduction in out -of-pocket expenses made by or on behalf 131
of the insured for a prescription drug. 132
(3) Each insurer issuing, delivering, or renewing a policy 133
in this state which provides prescription drug coverage, 134
regardless of whether the prescription drug benefits are 135
administered or managed by the insurer or by a pharmacy benefit 136
manager on behalf of the insurer, shall disclose, on its website 137
and in every policy issued, delivered, or renewed in this state 138
on or after January 1, 2023, that any amount paid by an insured 139
or by another person on behalf of the insured shall be applied 140
toward the insured's total contribution to any cost -sharing 141
requirement. 142
(4) This section applies to any group health insurance 143
policy issued, delivered, or renewed in this state on or after 144
January 1, 2023. 145
Section 5. Paragraph (c) is added to subsection (2) of 146
section 627.6572, Florida Statutes, to read: 147
627.6572 Pharmacy benefit manager contracts. — 148
(2) A contract between a health insurer and a pharmacy 149
benefit manager must require that the pharmacy benefit manager: 150
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(c)1. Apply any amount paid by an insured or by another 151
person on behalf of the insured toward the insured's total 152
contribution to any cost -sharing requirement pursuant to s. 153
627.65715. This subparagraph applies to any insured whose 154
insurance policy is issued, deliv ered, or renewed in this state 155
on or after January 1, 2023. 156
2. Disclose to every insured whose insurance policy is 157
issued, delivered, or renewed in this state on or after January 158
1, 2023, that the pharmacy benefit manager shall apply any 159
amount paid by the insured or by another person on behalf of the 160
insured toward the insured's total contribution to any cost -161
sharing requirement pursuant to s. 627.65715. 162
Section 6. Paragraph (e) of subsection (5) of section 163
627.6699, Florida Statutes, is amended to r ead: 164
627.6699 Employee Health Care Access Act. — 165
(5) AVAILABILITY OF COVERAGE. — 166
(e) All health benefit plans issued under this section 167
must comply with the following conditions: 168
1. For employers who have fewer than two employees, a late 169
enrollee may be excluded from coverage for no longer than 24 170
months if he or she was not covered by creditable coverage 171
continually to a date not more than 63 days before the effective 172
date of his or her new coverage. 173
2. Any requirement used by a small employer carr ier in 174
determining whether to provide coverage to a small employer 175
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group, including requirements for minimum participation of 176
eligible employees and minimum employer contributions, must be 177
applied uniformly among all small employer groups having the 178
same number of eligible employees applying for coverage or 179
receiving coverage from the small employer carrier, except that 180
a small employer carrier that participates in, administers, or 181
issues health benefits pursuant to s. 381.0406 which do not 182
include a preexisting condition exclusion may require as a 183
condition of offering such benefits that the employer has had no 184
health insurance coverage for its employees for a period of at 185
least 6 months. A small employer carrier may vary application of 186
minimum participatio n requirements and minimum employer 187
contribution requirements only by the size of the small employer 188
group. 189
3. In applying minimum participation requirements with 190
respect to a small employer, a small employer carrier shall not 191
consider as an eligible emp loyee employees or dependents who 192
have qualifying existing coverage in an employer -based group 193
insurance plan or an ERISA qualified self -insurance plan in 194
determining whether the applicable percentage of participation 195
is met. However, a small employer carr ier may count eligible 196
employees and dependents who have coverage under another health 197
plan that is sponsored by that employer. 198
4. A small employer carrier shall not increase any 199
requirement for minimum employee participation or any 200
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requirement for minim um employer contribution applicable to a 201
small employer at any time after the small employer has been 202
accepted for coverage, unless the employer size has changed, in 203
which case the small employer carrier may apply the requirements 204
that are applicable to th e new group size. 205
5. If a small employer carrier offers coverage to a small 206
employer, it must offer coverage to all the small employer's 207
eligible employees and their dependents. A small employer 208
carrier may not offer coverage limited to certain persons i n a 209
group or to part of a group, except with respect to late 210
enrollees. 211
6. A small employer carrier may not modify any health 212
benefit plan issued to a small employer with respect to a small 213
employer or any eligible employee or dependent through riders, 214
endorsements, or otherwise to restrict or exclude coverage for 215
certain diseases or medical conditions otherwise covered by the 216
health benefit plan. 217
7. An initial enrollment period of at least 30 days must 218
be provided. An annual 30 -day open enrollment peri od must be 219
offered to each small employer's eligible employees and their 220
dependents. A small employer carrier must provide special 221
enrollment periods as required by s. 627.65615. 222
8. A small employer carrier shall comply with s. 627.65715 223
with respect to contribution to cost -sharing requirements as 224
defined in subsection (1) of that section. 225
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Section 7. Subsection (48) is added to section 641.31, 226
Florida Statutes, to read: 227
641.31 Health maintenance contracts. — 228
(48)(a) As used in this subsection, the term "cost -sharing 229
requirement" means a dollar limit, deductible, copayment, 230
coinsurance, or any other out -of-pocket expense imposed on a 231
subscriber, including, but not limited to, the annual limitation 232
on cost sharing subject to 42 U.S.C. s. 18022. 233
(b)1. Each health maintenance organization issuing, 234
delivering, or renewing a health maintenance contract or 235
certificate in this state which provides prescription drug 236
coverage or each pharmacy benefit manager on behalf of such 237
health maintenance organization must apply any amount paid by a 238
subscriber or by another person on behalf of the subscriber 239
toward the subscriber's total contribution to any cost -sharing 240
requirement. 241
2. The amount paid by or on behalf of the sub scriber which 242
is applied toward the subscriber's total contribution to any 243
cost-sharing requirement under subparagraph 1. includes, but is 244
not limited to, any payment with, or any discount through, 245
financial assistance, a manufacturer copay card, a product 246
voucher, or any other reduction in out -of-pocket expenses made 247
by or on behalf of the subscriber for a prescription drug. 248
(c) Each health maintenance organization issuing, 249
delivering, or renewing a health maintenance contract or 250
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certificate in this stat e which provides prescription drug 251
coverage, regardless of whether the prescription drug benefits 252
are administered or managed by the health maintenance 253
organization or by a pharmacy benefit manager on behalf of the 254
health maintenance organization, shall di sclose, on its website 255
and in every subscriber's health maintenance contract, 256
certificate, or member handbook issued, delivered, or renewed in 257
this state on or after January 1, 2023, that any amount paid by 258
a subscriber or by another person on behalf of th e subscriber 259
shall be applied toward the subscriber's total contribution to 260
any cost-sharing requirement. 261
(d) This subsection applies to any health maintenance 262
contract or certificate issued, delivered, or renewed in this 263
state on or after January 1, 202 3. 264
Section 8. Paragraph (c) is added to subsection (2) of 265
section 641.314, Florida Statutes, to read: 266
641.314 Pharmacy benefit manager contracts. — 267
(2) A contract between a health maintenance organization 268
and a pharmacy benefit manager must require that the pharmacy 269
benefit manager: 270
(c)1. Apply any amount paid by a subscriber or by another 271
person on behalf of the subscriber toward the subscriber's total 272
contribution to any cost -sharing requirement pursuant to s. 273
641.31(48). This subparagraph applie s to any subscriber whose 274
health maintenance contract or certificate is issued, delivered, 275
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or renewed in this state on or after January 1, 2023. 276
2. Disclose to every subscriber whose health maintenance 277
contract or certificate is issued, delivered, or ren ewed in this 278
state on or after January 1, 2023, that the pharmacy benefit 279
manager shall apply any amount paid by the subscriber or by 280
another person on behalf of the subscriber toward the 281
subscriber's total contribution to any cost -sharing requirement 282
pursuant to s. 641.31(48). 283
Section 9. Paragraph (o) of subsection (2) of section 284
409.967, Florida Statutes, is amended to read: 285
409.967 Managed care plan accountability. — 286
(2) The agency shall establish such contract requirements 287
as are necessary for th e operation of the statewide managed care 288
program. In addition to any other provisions the agency may deem 289
necessary, the contract must require: 290
(o) Transparency.—Managed care plans shall comply with ss. 291
627.6385(4) ss. 627.6385(3) and 641.54(7). 292
Section 10. Paragraph (k) of subsection (1) of section 293
641.185, Florida Statutes, is amended to read: 294
641.185 Health maintenance organization subscriber 295
protections.— 296
(1) With respect to the provisions of this part and part 297
III, the principles expressed i n the following statements serve 298
as standards to be followed by the commission, the office, the 299
department, and the Agency for Health Care Administration in 300
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exercising their powers and duties, in exercising administrative 301
discretion, in administrative inte rpretations of the law, in 302
enforcing its provisions, and in adopting rules: 303
(k) A health maintenance organization subscriber shall be 304
given a copy of the applicable health maintenance contract, 305
certificate, or member handbook specifying: all the provisio ns, 306
disclosure, and limitations required pursuant to s. 641.31(1) , 307
and (4), and (48); the covered services, including those 308
services, medical conditions, and provider types specified in 309
ss. 641.31, 641.31094, 641.31095, 641.31096, 641.51(11), and 310
641.513; and where and in what manner services may be obtained 311
pursuant to s. 641.31(4). 312
Section 11. The Legislature finds that this act fulfills 313
an important state interest. 314
Section 12. This act shall take effect July 1, 2022. 315