HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 1 of 14 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 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 HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 2 of 14 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 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 HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 3 of 14 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 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 HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 4 of 14 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 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 HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 5 of 14 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 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 HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 6 of 14 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 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 HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 7 of 14 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 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 HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 8 of 14 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 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 HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 9 of 14 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 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 HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 10 of 14 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 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 HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 11 of 14 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 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 HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 12 of 14 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 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 HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 13 of 14 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 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 HB 1063 2023 CODING: Words stricken are deletions; words underlined are additions. hb1063-00 Page 14 of 14 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 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