Florida 2023 2023 Regular Session

Florida House Bill H1063 Introduced / Bill

Filed 02/22/2023

                       
 
HB 1063  	2023 
 
 
 
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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 tow ard the 6 
total contributions of the insureds' cost -sharing 7 
requirements; providing construction; providing 8 
applicability; amending s. 627.6385, F.S.; providing 9 
disclosure requirements; providing applicability; 10 
amending s. 627.64741, F.S.; requiring specifie d 11 
contracts to require pharmacy benefit managers to 12 
apply payments by or on behalf of insureds toward the 13 
insureds' total contributions to cost -sharing 14 
requirements; providing applicability; providing 15 
disclosure requirements; creating s. 627.65715, F.S.; 16 
defining the term "cost -sharing requirement"; 17 
requiring specified group health insurers and their 18 
pharmacy benefit managers to apply payments by or on 19 
behalf of insureds toward the total contributions of 20 
the insureds' cost-sharing requirements; providing 21 
construction; providing disclosure requirements; 22 
providing applicability; amending s. 627.6572, F.S.; 23 
requiring specified contracts to require pharmacy 24 
benefit managers to apply payments by or on behalf of 25     
 
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insureds toward the insureds' total contributions to 26 
cost-sharing requirements; providing applicability; 27 
providing disclosure requirements; amending s. 28 
627.6699, F.S.; requiring small employer carriers to 29 
comply with certain cost -sharing requirements; making 30 
technical changes; amending s. 641.31, F.S.; defi ning 31 
the term "cost-sharing requirement"; requiring 32 
specified health maintenance organizations and their 33 
pharmacy benefit managers to apply payments by or on 34 
behalf of subscribers toward the total contributions 35 
of the subscribers' cost -sharing requirements ; 36 
providing construction; providing disclosure 37 
requirements; providing applicability; amending s. 38 
641.314, F.S.; requiring specified contracts to 39 
require pharmacy benefit managers to apply payments by 40 
or on behalf of subscribers toward the subscribers' 41 
total contributions to cost -sharing requirements; 42 
providing applicability; providing disclosure 43 
requirements; amending s. 409.967, F.S.; conforming a 44 
cross-reference; amending s. 641.185, F.S.; conforming 45 
a provision to changes made by the act; providing a 46 
declaration of important state interest; providing an 47 
effective date. 48 
 49 
Be It Enacted by the Legislature of the State of Florida: 50     
 
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 51 
 Section 1.  Section 627.6383, Florida Statutes, is created 52 
to read: 53 
 627.6383  Cost-sharing requirements. — 54 
 (1)  As used in this section, the term "cost -sharing 55 
requirement" means a dollar limit, a deductible, a copayment, 56 
coinsurance, or any other out -of-pocket expense imposed on an 57 
insured, including, but not limited to, the annual limitation on 58 
cost sharing subject to 42 U.S.C. s. 18022. 59 
 (2)(a)  Each health insurer issuing, delivering, or 60 
renewing a policy in this state which provides prescription drug 61 
coverage, or each pharmacy benefit manager on behalf of such 62 
health insurer, shall apply any amount paid by an insured or by 63 
another person on behalf of the insured toward the insured's 64 
total contribution to any cost -sharing requirement. 65 
 (b)  The amount paid by or on behalf of the insured which 66 
is applied toward the insured's total contribution to any cost -67 
sharing requirement under paragraph (a) includes, but is not 68 
limited to, any payment with or any discount through financial 69 
assistance, a manufacturer copay card, a product voucher, or any 70 
other reduction in out -of-pocket expenses made by or on behalf 71 
of the insured for a prescription drug. 72 
 (3)  This section applies to any health insurance policy 73 
issued, delivered, or renewed in this state on or after January 74 
1, 2024. 75     
 
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 Section 2.  Present subsections (2) and (3) of section 76 
627.6385, Florida Statutes, are redesignated as subsections (3) 77 
and (4), respectively, a new subsection (2) is added to that 78 
section, and present subsection (2) of that section is amended, 79 
to read: 80 
 627.6385  Disclosures to policyholders; calculations of 81 
cost sharing.— 82 
 (2)  Each health insurer issuing, delivering, or renewing a 83 
policy in this state which provides prescription drug coverage, 84 
regardless of whether the prescription drug benefits are 85 
administered or managed by the health insurer or by a pharmacy 86 
benefit manager on behalf of the health insur er, shall disclose 87 
on its website that any amount paid by a policyholder or by 88 
another person on behalf of the policyholder must be applied 89 
toward the policyholder's total contribution to any cost -sharing 90 
requirement pursuant to s. 627.6383. This subsectio n applies to 91 
any policy issued, delivered, or renewed in this state on or 92 
after January 1, 2024. 93 
 (3)(2) Each health insurer shall include in every policy 94 
delivered or issued for delivery to any person in this the state 95 
or in materials provided as require d by s. 627.64725 a notice 96 
that the information required by this section is available 97 
electronically and the website address of the website where the 98 
information can be accessed. In addition, each health insurer 99 
issuing, delivering, or renewing a policy in this state which 100     
 
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provides prescription drug coverage, regardless of whether the 101 
prescription drug benefits are administered or managed by the 102 
health insurer or by a pharmacy benefit manager on behalf of the 103 
health insurer, shall include in every policy th at is issued, 104 
delivered, or renewed to any person in this state on or after 105 
January 1, 2024, the disclosure that any amount paid by a 106 
policyholder or by another person on behalf of the policyholder 107 
must be applied toward the policyholder's total contributi on to 108 
any cost-sharing requirement pursuant to s. 627.6383. 109 
 Section 3.  Paragraph (c) is added to subsection (2) of 110 
section 627.64741, Florida Statutes, to read: 111 
 627.64741  Pharmacy benefit manager contracts. — 112 
 (2)  A contract between a health insurer and a pharmacy 113 
benefit manager must require that the pharmacy benefit manager: 114 
 (c)1.  Apply any amount paid by an insured or by another 115 
person on behalf of the insured toward the insured's total 116 
contribution to any cost -sharing requirement pursuant to s. 117 
627.6383. This subparagraph applies to any insured whose 118 
insurance policy is issued, delivered, or renewed in this state 119 
on or after January 1, 2024. 120 
 2.  Disclose to every insured whose insurance policy is 121 
issued, delivered, or renewed in this state on or after January 122 
1, 2024, that the pharmacy benefit manager shall apply any 123 
amount paid by the insured or by another person on behalf of the 124 
insured toward the insured's total contribution to any cost -125     
 
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sharing requirement pursuant to s. 627.6383. 126 
 Section 4.  Section 627.65715, Florida Statutes, is created 127 
to read: 128 
 627.65715  Cost-sharing requirements. — 129 
 (1)  As used in this section, the term "cost -sharing 130 
requirement" means a dollar limit, a deductible, a copayment, 131 
coinsurance, or any other out -of-pocket expense imposed on an 132 
insured, including, but not limited to, the annual limitation on 133 
cost sharing subject to 42 U.S.C. s. 18022. 134 
 (2)(a)  Each insurer issuing, delivering, or renewing a 135 
policy in this state which provides prescription drug coverage, 136 
or each pharmacy benefit manager on behalf of such insurer, 137 
shall apply any amount paid by an insured or by another person 138 
on behalf of the insured toward the insured's total contribution 139 
to any cost-sharing requirement. 140 
 (b)  The amount paid by or on behalf o f the insured which 141 
is applied toward the insured's total contribution to any cost -142 
sharing requirement under paragraph (a) includes, but is not 143 
limited to, any payment with or any discount through financial 144 
assistance, a manufacturer copay card, a product voucher, or any 145 
other reduction in out -of-pocket expenses made by or on behalf 146 
of the insured for a prescription drug. 147 
 (3)  Each insurer issuing, delivering, or renewing a policy 148 
in this state which provides prescription drug coverage, 149 
regardless of whether the prescription drug benefits are 150     
 
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administered or managed by the insurer or by a pharmacy benefit 151 
manager on behalf of the insurer, shall disclose on its website 152 
and in every policy issued, delivered, or renewed in this state 153 
on or after January 1, 202 4, that any amount paid by an insured 154 
or by another person on behalf of the insured must be applied 155 
toward the insured's total contribution to any cost -sharing 156 
requirement. 157 
 (4)  This section applies to any group health insurance 158 
policy issued, delivered, or renewed in this state on or after 159 
January 1, 2024. 160 
 Section 5.  Paragraph (c) is added to subsection (2) of 161 
section 627.6572, Florida Statutes, to read: 162 
 627.6572  Pharmacy benefit manager contracts. — 163 
 (2)  A contract between a health insurer and a ph armacy 164 
benefit manager must require that the pharmacy benefit manager: 165 
 (c)1.  Apply any amount paid by an insured or by another 166 
person on behalf of the insured toward the insured's total 167 
contribution to any cost -sharing requirement pursuant to s. 168 
627.65715. This subparagraph applies to any insured whose 169 
insurance policy is issued, delivered, or renewed in this state 170 
on or after January 1, 2024. 171 
 2.  Disclose to every insured whose insurance policy is 172 
issued, delivered, or renewed in this state on or after January 173 
1, 2024, that the pharmacy benefit manager shall apply any 174 
amount paid by the insured or by another person on behalf of the 175     
 
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insured toward the insured's total contribution to any cost -176 
sharing requirement pursuant to s. 627.65715. 177 
 Section 6.  Paragraph (e) of subsection (5) of section 178 
627.6699, Florida Statutes, is amended to read: 179 
 627.6699  Employee Health Care Access Act. — 180 
 (5)  AVAILABILITY OF COVERAGE. — 181 
 (e)  All health benefit plans issued under this section 182 
must comply with the following co nditions: 183 
 1.  For employers who have fewer than two employees, a late 184 
enrollee may be excluded from coverage for no longer than 24 185 
months if he or she was not covered by creditable coverage 186 
continually to a date not more than 63 days before the effective 187 
date of his or her new coverage. 188 
 2.  Any requirement used by a small employer carrier in 189 
determining whether to provide coverage to a small employer 190 
group, including requirements for minimum participation of 191 
eligible employees and minimum employer contrib utions, must be 192 
applied uniformly among all small employer groups having the 193 
same number of eligible employees applying for coverage or 194 
receiving coverage from the small employer carrier, except that 195 
a small employer carrier that participates in, administe rs, or 196 
issues health benefits pursuant to s. 381.0406 which do not 197 
include a preexisting condition exclusion may require as a 198 
condition of offering such benefits that the employer has had no 199 
health insurance coverage for its employees for a period of at 200     
 
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least 6 months. A small employer carrier may vary application of 201 
minimum participation requirements and minimum employer 202 
contribution requirements only by the size of the small employer 203 
group. 204 
 3.  In applying minimum participation requirements with 205 
respect to a small employer, a small employer carrier may shall 206 
not consider as an eligible employee employees or dependents who 207 
have qualifying existing coverage in an employer -based group 208 
insurance plan or an ERISA qualified self -insurance plan in 209 
determining whether the applicable percentage of participation 210 
is met. However, a small employer carrier may count eligible 211 
employees and dependents who have coverage under another health 212 
plan that is sponsored by that employer. 213 
 4.  A small employer carrier may shall not increase any 214 
requirement for minimum employee participation or any 215 
requirement for minimum employer contribution applicable to a 216 
small employer at any time after the small employer has been 217 
accepted for coverage, unless the employer size has changed, in 218 
which case the small employer carrier may apply the requirements 219 
that are applicable to the new group size. 220 
 5.  If a small employer carrier offers coverage to a small 221 
employer, it must offer coverage to all the small employer's 222 
eligible employees and the ir dependents. A small employer 223 
carrier may not offer coverage limited to certain persons in a 224 
group or to part of a group, except with respect to late 225     
 
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enrollees. 226 
 6.  A small employer carrier may not modify any health 227 
benefit plan issued to a small employ er with respect to a small 228 
employer or any eligible employee or dependent through riders, 229 
endorsements, or otherwise to restrict or exclude coverage for 230 
certain diseases or medical conditions otherwise covered by the 231 
health benefit plan. 232 
 7.  An initial enrollment period of at least 30 days must 233 
be provided. An annual 30 -day open enrollment period must be 234 
offered to each small employer's eligible employees and their 235 
dependents. A small employer carrier must provide special 236 
enrollment periods as required by s. 627.65615. 237 
 8.  A small employer carrier shall comply with s. 627.65715 238 
with respect to contribution to cost -sharing requirements, as 239 
defined in that section. 240 
 Section 7.  Subsection (48) is added to section 641.31, 241 
Florida Statutes, to read: 242 
 641.31  Health maintenance contracts. — 243 
 (48)(a)  As used in this subsection, the term "cost -sharing 244 
requirement" means a dollar limit, a deductible, a copayment, 245 
coinsurance, or any other out -of-pocket expense imposed on a 246 
subscriber, including, but not limited t o, the annual limitation 247 
on cost sharing subject to 42 U.S.C. s. 18022. 248 
 (b)1.  Each health maintenance organization issuing, 249 
delivering, or renewing a health maintenance contract or 250     
 
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certificate in this state which provides prescription drug 251 
coverage, or each pharmacy benefit manager on behalf of such 252 
health maintenance organization, shall apply any amount paid by 253 
a subscriber or by another person on behalf of the subscriber 254 
toward the subscriber's total contribution to any cost -sharing 255 
requirement. 256 
 2.  The amount paid by or on behalf of the subscriber which 257 
is applied toward the subscriber's total contribution to any 258 
cost-sharing requirement under subparagraph 1. includes, but is 259 
not limited to, any payment with or any discount through 260 
financial assistance, a manufacturer copay card, a product 261 
voucher, or any other reduction in out -of-pocket expenses made 262 
by or on behalf of the subscriber for a prescription drug. 263 
 (c)  Each health maintenance organization issuing, 264 
delivering, or renewing a health maintenan ce contract or 265 
certificate in this state which provides prescription drug 266 
coverage, regardless of whether the prescription drug benefits 267 
are administered or managed by the health maintenance 268 
organization or by a pharmacy benefit manager on behalf of the 269 
health maintenance organization, shall disclose on its website 270 
and in every subscriber's health maintenance contract, 271 
certificate, or member handbook issued, delivered, or renewed in 272 
this state on or after January 1, 2024, that any amount paid by 273 
a subscriber or by another person on behalf of the subscriber 274 
must be applied toward the subscriber's total contribution to 275     
 
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any cost-sharing requirement. 276 
 (d)  This subsection applies to any health maintenance 277 
contract or certificate issued, delivered, or renewed in this 278 
state on or after January 1, 2024. 279 
 Section 8.  Paragraph (c) is added to subsection (2) of 280 
section 641.314, Florida Statutes, to read: 281 
 641.314  Pharmacy benefit manager contracts. — 282 
 (2)  A contract between a health maintenance organization 283 
and a pharmacy benefit manager must require that the pharmacy 284 
benefit manager: 285 
 (c)1.  Apply any amount paid by a subscriber or by another 286 
person on behalf of the subscriber toward the subscriber's total 287 
contribution to any cost -sharing requirement pursuant to s. 288 
641.31(48). This subparagraph applies to any subscriber whose 289 
health maintenance contract or certificate is issued, delivered, 290 
or renewed in this state on or after January 1, 2024. 291 
 2.  Disclose to every subscriber whose health maintenance 292 
contract or certificate is issued, delivered, or renewed in this 293 
state on or after January 1, 2024, that the pharmacy benefit 294 
manager shall apply any amount paid by the subscriber or by 295 
another person on behalf of the subscriber toward the 296 
subscriber's total contribution to any cost-sharing requirement 297 
pursuant to s. 641.31(48). 298 
 Section 9.  Paragraph (o) of subsection (2) of section 299 
409.967, Florida Statutes, is amended to read: 300     
 
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 409.967  Managed care plan accountability. — 301 
 (2)  The agency shall establish such contract requirements 302 
as are necessary for the operation of the statewide managed care 303 
program. In addition to any other provisions the agency may deem 304 
necessary, the contract must require: 305 
 (o)  Transparency.—Managed care plans shall comply with ss. 306 
627.6385(4) and 641.54(7) ss. 627.6385(3) and 641.54(7) . 307 
 Section 10.  Paragraph (k) of subsection (1) of section 308 
641.185, Florida Statutes, is amended to read: 309 
 641.185  Health maintenance organization subscriber 310 
protections.— 311 
 (1)  With respect to the provisions of this part and part 312 
III, the principles expressed in the following statements serve 313 
as standards to be followed by the commission, the office, the 314 
department, and the Agency for Health Care Administration in 315 
exercising their powers and duties, in exercisin g administrative 316 
discretion, in administrative interpretations of the law, in 317 
enforcing its provisions, and in adopting rules: 318 
 (k)  A health maintenance organization subscriber shall be 319 
given a copy of the applicable health maintenance contract, 320 
certificate, or member handbook specifying: all the provisions, 321 
disclosure, and limitations required pursuant to s. 641.31(1) , 322 
and (4), and (48); the covered services, including those 323 
services, medical conditions, and provider types specified in 324 
ss. 641.31, 641.31094, 641.31095, 641.31096, 641.51(11), and 325     
 
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641.513; and where and in what manner services may be obtained 326 
pursuant to s. 641.31(4). 327 
 Section 11.  The Legislature finds that this act fulfills 328 
an important state interest. 329 
 Section 12.  This act shall take effect July 1, 2023. 330