Florida 2023 Regular Session

Florida House Bill H0203 Compare Versions

Only one version of the bill is available at this time.

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3	3	HB 203 2023
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10	10	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
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14	14	A bill to be entitled 1
15	15	An act relating to access to pharmacies and 2
16	16	prescription drugs under insurance and pharmacy 3
17	17	benefit managers policies; amending s. 624.3161, F.S.; 4
18	18	requiring the Office of Insurance Regulation to 5
19	19	examine pharmacy benefit managers to ascertain 6
20	20	compliance with specified laws; conforming a provision 7
21	21	to changes made by the act; amending s. 624.490, F.S.; 8
22	22	requiring the office to suspend or revoke 9
23	23	registrations for pharmacy benefit managers and impose 10
24	24	fines and civil penalties for certain violations; 11
25	25	providing fines and civil penalties; providing that 12
26	26	such violations are unfair methods of competition or 13
27	27	unfair or deceptive acts or practices; providing that 14
28	28	such violations are subject to certain actions, 15
29	29	remedies, and penalties; providing applicability; 16
30	30	creating s. 624.4901, F.S.; providing purpose; 17
31	31	providing definitions; requiring pharmacy benefit 18
32	32	managers to establish pharmacy benefit networks for a 19
33	33	specified purpose; requiring pharmacy benefit managers 20
34	34	to have standard contracts with pharmacies; providing 21
35	35	requirements for such contracts' terms and conditions; 22
36	36	requiring pharmacy benefit managers to provide copies 23
37	37	of such standard contracts within a specified 24
38	38	timeframe to requesting pharmacies and pharmacists; 25
39	39
40	40	HB 203 2023
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47	47	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
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49	49
50	50
51	51	prohibiting pharmacy benefit managers from denying 26
52	52	pharmacies and pharmacists in the state the right to 27
53	53	participate as contract providers under certain 28
54	54	circumstances; providing construction; authorizing 29
55	55	certain persons and entities to bring actions and 30
56	56	injunctive relief under certain circumstances; 31
57	57	authorizing the Department of Financial Services to 32
58	58	adopt rules; creating s. 624.4902, F.S.; providing 33
59	59	purpose; providing definitions; prohibiting pharmacy 34
60	60	benefit managers from engaging in certain acts against 35
61	61	patients and covered individuals; providing that such 36
62	62	acts are unfair methods of competition or unfair or 37
63	63	deceptive acts or practices; providing that such acts 38
64	64	are subject to certain actions, remedies, and 39
65	65	penalties; authorizing the department to adopt rules; 40
66	66	creating s. 627.42398, F.S.; providing definitions; 41
67	67	prohibiting health insurers and pharmacy benefit 42
68	68	managers from engaging in certain acts relating to 43
69	69	covered clinician-administered drugs; providing that 44
70	70	such acts constitute unfair methods of competition or 45
71	71	unfair or deceptive acts or practices and are subje ct 46
72	72	to certain actions, remedies, and penalties; providing 47
73	73	an effective date. 48
74	74	49
75	75	Be It Enacted by the Legislature of the State of Florida: 50
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77	77	HB 203 2023
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84	84	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
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88	88	51
89	89	Section 1. Subsections (1) and (3) of section 624.3161, 52
90	90	Florida Statutes, are amended to read: 53
91	91	624.3161 Market conduct examinations. — 54
92	92	(1) As often as it deems necessary, the office shall 55
93	93	examine each pharmacy benefit manager as defined in s. 624.490, 56
94	94	each licensed rating organization, each advisory organization, 57
95	95	each group, association, carrier, as defined in s . 440.02, or 58
96	96	other organization of insurers which engages in joint 59
97	97	underwriting or joint reinsurance, and each authorized insurer 60
98	98	transacting in this state any class of insurance to which the 61
99	99	provisions of chapter 627 are applicable. The examination shall 62
100	100	be for the purpose of ascertaining compliance by the person 63
101	101	examined with the applicable provisions of chapters 440, 624, 64
102	102	626, 627, and 635. 65
103	103	(3) The examination may be conducted by an independent 66
104	104	professional examiner under contract to the office, in whi ch 67
105	105	case payment shall be made directly to the contracted examiner 68
106	106	by the entity insurer examined in accordance with the rates and 69
107	107	terms agreed to by the office and the examiner. 70
108	108	Section 2. Subsections (6) and (7) of section 624.490, 71
109	109	Florida Statutes, are renumbered as subsections (8) and (9), 72
110	110	respectively, and new subsections (6) and (7) are added to that 73
111	111	section, to read: 74
112	112	624.490 Registration of pharmacy benefit managers. — 75
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121	121	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
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125	125	(6)(a) The office may suspend or revoke a pharmacy benefit 76
126	126	manager's registration or impose a fine or civil penalty if it 77
127	127	finds that the pharmacy benefit manager has violated s. 78
128	128	624.4901, s. 624.4902, s. 624.491, s. 627.42398, s. 627.6131, s. 79
129	129	627.64741, s. 627.6572, s. 641.314, or s. 641.3155. The fine or 80
130	130	civil penalty shall be in the amount of $10,000 for each 81
131	131	violation, which shall accrue for each day the pharmacy benefit 82
132	132	manager is in violation of the law. 83
133	133	(b) The violation of any section enumerated in paragraph 84
134	134	(a) constitutes an unfair method of competition or an unfair or 85
135	135	deceptive act or practice, subject to actions, remedies, and 86
136	136	penalties provided by the Florida Deceptive and Unfair Trade 87
137	137	Practices Act and consumer protection laws. 88
138	138	(7) Subsection (6) applies to contracts between a pharmacy 89
139	139	benefit manager and a pharmacy that participates in a retail 90
140	140	pharmacy network of the pharmacy benefit manager. 91
141	141	Section 3. Section 624.4901, Florida Statutes, is created 92
142	142	to read: 93
143	143	624.4901 Pharmacy benefit manager contracts with 94
144	144	pharmacies.— 95
145	145	(1) The purpose of this section is to give patients 96
146	146	convenient access to affordable prescription drugs through a 97
147	147	pharmacy of their choice. 98
148	148	(2) As used in this section, the term: 99
149	149	(a) "Affiliate" means a pharmacy in which a pharmacy 100
150	150
151	151	HB 203 2023
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158	158	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
159	159
160	160
161	161
162	162	benefit manager, directly or indirectly, has an investment or 101
163	163	ownership interest or shares common ownership. 102
164	164	(b) "Pharmacy" means a pharmacy licensed under chapter 103
165	165	465, a nonresident pharmacy registered under s. 465.0156, or a 104
166	166	nonresident pharmacy or outsourcing facility holding an active 105
167	167	permit pursuant to s. 4 65.0158 to dispense drugs to patients 106
168	168	located in this state. 107
169	169	(c) "Pharmacy benefit manager" has the same meaning as in 108
170	170	s. 624.490(1). 109
171	171	(3) A pharmacy benefit manager shall establish a 110
172	172	reasonably adequate and accessible pharmacy benefit network to 111
173	173	provide patients with convenient access to prescription drugs 112
174	174	through pharmacies that are located within a reasonable distance 113
175	175	from a patient's residence. 114
176	176	(4) A pharmacy benefit manager shall have a standard 115
177	177	contract with reasonable and relevant terms and cond itions of 116
178	178	participation in the pharmacy benefit network, whereby any 117
179	179	willing pharmacy may participate as a network pharmacy. Terms 118
180	180	and conditions must include provisions reasonable and relevant 119
181	181	to unique pharmacy, pharmacy business, and pharmacy service 120
182	182	models. 121
183	183	(5) A pharmacy benefit manager shall provide a copy of the 122
184	184	standard contract to a requesting pharmacy or pharmacist within 123
185	185	7 business days after receiving such a request from the pharmacy 124
186	186	or pharmacist. 125
187	187
188	188	HB 203 2023
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195	195	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
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199	199	(6) If a pharmacy benefit manager's affilia te participates 126
200	200	in the pharmacy benefit network, the pharmacy benefit manager 127
201	201	may not deny another pharmacy or pharmacist in this state the 128
202	202	right to participate as a contract provider under the policy or 129
203	203	plan, provided that the pharmacy or pharmacist agree s to: 130
204	204	(a) Provide pharmaceutical services that meet all 131
205	205	reasonable and relevant terms and conditions. 132
206	206	(b) Include the same administrative, financial, and 133
207	207	professional conditions that apply to pharmacy and pharmacists 134
208	208	that have been designated as provid ers under the policy or plan. 135
209	209	(7) The decision of a pharmacy or pharmacist to accept a 136
210	210	contract with the pharmacy benefit manager is not admissible 137
211	211	proof that the contract is reasonable and relevant. 138
212	212	(8) Without regard to any other remedy or relief to which 139
213	213	a pharmacy is entitled, a pharmacy, a pharmacist, or a person, 140
214	214	firm, corporation, association, entity, or any agent or employee 141
215	215	of a pharmacy or pharmacist which is aggrieved by a violation of 142
216	216	this section may bring an action to recover damages, plus 143
217	217	attorney fees and costs, and injunctive relief. 144
218	218	(9) The department may adopt rules to implement this 145
219	219	section. 146
220	220	Section 4. Section 624.4902, Florida Statutes, is created 147
221	221	to read: 148
222	222	624.4902 Pharmacy benefit managers' prohibited acts. — 149
223	223	(1) The purpose of this section is to protect patient 150
224	224
225	225	HB 203 2023
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232	232	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
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234	234
235	235
236	236	welfare by establishing minimum standards for patient access to 151
237	237	a pharmacy provider and by prohibiting restrictions imposed by a 152
238	238	pharmacy benefit manager on a patient's right to choose a 153
239	239	pharmacy. 154
240	240	(2) As used in this section, the term: 155
241	241	(a) "Affiliate" means a pharmacy in which a pharmacy 156
242	242	benefit manager, directly or indirectly, has an investment or 157
243	243	ownership interest or shares common ownership. As used in this 158
244	244	paragraph, the term "pharmacy" has the same meaning as in s. 159
245	245	624.4901(2). 160
246	246	(b) "Pharmacy benefit manager" has the same meaning as in 161
247	247	s. 624.490(1). 162
248	248	(c) "Wholesale acquisition cost" means the amount that a 163
249	249	pharmaceutical wholesaler charges for a pharmaceutical product 164
250	250	as listed on the pharmacy's billing inv oice. 165
251	251	(3) A pharmacy benefit manager may not: 166
252	252	(a) Offer, incentivize, or implement a plan design that 167
253	253	requires a patient or covered individual to use an affiliate; 168
254	254	(b) Refer or incentivize a patient or covered individual 169
255	255	to use an affiliate or any ph armacy in which the pharmacy 170
256	256	benefit manager has any direct or indirect financial interest or 171
257	257	ownership; 172
258	258	(c) Restrict the choice of a patient or covered individual 173
259	259	of an in-network provider for prescription drugs; 174
260	260	(d) Reimburse a pharmacy or pharmacist in this state an 175
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269	269	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
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273	273	amount less than the amount that the pharmacy benefit manager 176
274	274	reimburses an affiliate for providing the same drug products, 177
275	275	drug product ingredients, or pharmacist services; or 178
276	276	(e) Reimburse a pharmacy or pharmacist in this state for a 179
277	277	drug product, drug product ingredient, or pharmacist services an 180
278	278	amount less than the national average drug acquisition cost, or, 181
279	279	if the national average drug acquisition cost is unavailable, 182
280	280	the wholesale acquisition cost. 183
281	281	(4) The commission of any act prohibited under subsection 184
282	282	(3) constitutes an unfair method of competition or an unfair or 185
283	283	deceptive act or practice, subject to actions, remedies, and 186
284	284	penalties provided by the Florida Deceptive and Unfair Trade 187
285	285	Practices Act and consumer protection laws . 188
286	286	(5) The department may adopt rules necessary to implement 189
287	287	this section. 190
288	288	Section 5. Section 627.42398, Florida Statutes, is created 191
289	289	to read: 192
290	290	627.42398 Coverage of clinician -administered drugs by 193
291	291	health insurers and pharmacy benefit managers. — 194
292	292	(1) As used in this section, the term: 195
293	293	(a) "Clinician-administered drug" means a prescription 196
294	294	drug other than a vaccine which: 197
295	295	1. Has not been approved by the United States Food and 198
296	296	Drug Administration as a self -administered drug or self -199
297	297	administered biologic, or cannot reasonably be administered by 200
298	298
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306	306	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
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308	308
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310	310	the patient to whom the drug is prescribed or by an individual 201
311	311	other than a health care provider. 202
312	312	2. Is typically administered in a physician's office, 203
313	313	hospital, outpatient infusion center, or other clinical setting. 204
314	314	(b) "Health care provider" means a health care 205
315	315	professional, health care facility, or entity licensed or 206
316	316	certified to provide health care services in this state which 207
317	317	meets the criteria established by the Department of Health. 208
318	318	(c) "Insurer" means an insurer as defined in s. 624.03 209
319	319	which provides health insurance coverage, a multiple -employer 210
320	320	welfare arrangement as def ined in s. 624.437(1), self -insurance 211
321	321	as defined in s. 624.031, a prepaid limited health service 212
322	322	organization as defined in s. 636.003(7), a health maintenance 213
323	323	organization as defined in s. 641.19(12), a prepaid health 214
324	324	clinic as defined in s. 641.402, a fr aternal benefit society as 215
325	325	defined in s. 632.601 which provides health care benefits, or 216
326	326	any health care arrangement that assumes some risk. 217
327	327	(d) "Participating provider" means a health care provider 218
328	328	that participates in the network of an insurer or pharm acy 219
329	329	benefit manager. 220
330	330	(e) "Pharmacy benefit manager" has the same meaning as in 221
331	331	s. 624.490(1). 222
332	332	(f) "White bagging" means the policy of an insurer or 223
333	333	pharmacy benefit manager which requires a prescription drug to 224
334	334	be: 225
335	335
336	336	HB 203 2023
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343	343	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
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347	347	1. Dispensed by a specialty pharmac y selected by the 226
348	348	insurer or pharmacy benefit manager. 227
349	349	2. Transported to a health care provider for 228
350	350	administration to a patient. 229
351	351	230
352	352	As used in this paragraph, the term "specialty pharmacy" means a 231
353	353	pharmacy that focuses on high -cost medications and personal ized 232
354	354	support for patients with chronic or complex conditions. 233
355	355	(2) An insurer or pharmacy benefit manager that covers a 234
356	356	clinician-administered drug may not: 235
357	357	(a) Condition, deny, or reduce payment to a participating 236
358	358	provider for providing the covered cli nician-administered drug 237
359	359	and related services to an insured if all the criteria for the 238
360	360	medical necessity for providing and administering the clinician -239
361	361	administered drug are met, regardless of whether the clinician -240
362	362	administered drug is obtained from a phar macy selected by the 241
363	363	insurer or pharmacy benefit manager. For the purposes of this 242
364	364	section, the location of receiving the clinician -administered 243
365	365	drug may not be considered a medical necessity criterion. 244
366	366	(b) Interfere with the insured's right to choose to obtain 245
367	367	the covered clinician -administered drug from a participating 246
368	368	provider or a pharmacy of choice, through any inducement, 247
369	369	steering, or financial or other incentive offer. 248
370	370	(c) Require the covered clinician -administered drug to be 249
371	371	dispensed by a pharm acy selected by the insurer or pharmacy 250
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380	380	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
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384	384	benefit manager, including, but not limited to, through white 251
385	385	bagging. 252
386	386	(d) If the covered clinician -administered drug is not 253
387	387	dispensed by a pharmacy selected by the insurer or pharmacy 254
388	388	benefit manager: 255
389	389	1. Reimburse for the clinician -administered drug at a 256
390	390	lesser amount than the amount that would otherwise be 257
391	391	reimbursed; 258
392	392	2. Limit or exclude coverage or benefits for the 259
393	393	clinician-administered drug; or 260
394	394	3. Require the insured to pay an additional fee, a higher 261
395	395	copayment, a higher coinsurance, a second copayment, a second 262
396	396	coinsurance, or any other form of an increased cost -sharing 263
397	397	amount over the price paid for the clinician -administered drug 264
398	398	dispensed by a pharmacy selected by the insurer or pharmacy 265
399	399	benefit manager. 266
400	400	(e) Require that the covered clinician -administered drug 267
401	401	be administered using home infusion or be sent directly to a 268
402	402	third party or to the insured for home infusion, unless the 269
403	403	insured's treating physician determines that home infusion of 270
404	404	the clinician-administered drug will not jeopardize the 271
405	405	insured's health. 272
406	406	(3) The commission of any act prohibited under subsection 273
407	407	(2) constitutes an unfair method of competition or an unfair or 274
408	408	deceptive act or practice, subject to actions, remedies, and 275
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417	417	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
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421	421	penalties provided by the Florida Deceptive and Unfair Trade 276
422	422	Practices Act and consumer protection laws. 277
423	423	Section 6. This act shall take effect July 1, 2023. 278