Florida 2023 Regular Session

Florida House Bill H1063 Compare Versions

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

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3	3	HB 1063 2023
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7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb1063-00
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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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13	13
14	14	A bill to be entitled 1
15	15	An act relating to health insurance cost sharing; 2
16	16	creating s. 627.6383, F.S.; defining the term "cost -3
17	17	sharing requirement"; requiring specified individual 4
18	18	health insurers and their pharmacy benefit managers to 5
19	19	apply payments by or on behalf of insureds tow ard the 6
20	20	total contributions of the insureds' cost -sharing 7
21	21	requirements; providing construction; providing 8
22	22	applicability; amending s. 627.6385, F.S.; providing 9
23	23	disclosure requirements; providing applicability; 10
24	24	amending s. 627.64741, F.S.; requiring specifie d 11
25	25	contracts to require pharmacy benefit managers to 12
26	26	apply payments by or on behalf of insureds toward the 13
27	27	insureds' total contributions to cost -sharing 14
28	28	requirements; providing applicability; providing 15
29	29	disclosure requirements; creating s. 627.65715, F.S.; 16
30	30	defining the term "cost -sharing requirement"; 17
31	31	requiring specified group health insurers and their 18
32	32	pharmacy benefit managers to apply payments by or on 19
33	33	behalf of insureds toward the total contributions of 20
34	34	the insureds' cost-sharing requirements; providing 21
35	35	construction; providing disclosure requirements; 22
36	36	providing applicability; amending s. 627.6572, F.S.; 23
37	37	requiring specified contracts to require pharmacy 24
38	38	benefit managers to apply payments by or on behalf of 25
39	39
40	40	HB 1063 2023
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42	42
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45	45	hb1063-00
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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	insureds toward the insureds' total contributions to 26
52	52	cost-sharing requirements; providing applicability; 27
53	53	providing disclosure requirements; amending s. 28
54	54	627.6699, F.S.; requiring small employer carriers to 29
55	55	comply with certain cost -sharing requirements; making 30
56	56	technical changes; amending s. 641.31, F.S.; defi ning 31
57	57	the term "cost-sharing requirement"; requiring 32
58	58	specified health maintenance organizations and their 33
59	59	pharmacy benefit managers to apply payments by or on 34
60	60	behalf of subscribers toward the total contributions 35
61	61	of the subscribers' cost -sharing requirements ; 36
62	62	providing construction; providing disclosure 37
63	63	requirements; providing applicability; amending s. 38
64	64	641.314, F.S.; requiring specified contracts to 39
65	65	require pharmacy benefit managers to apply payments by 40
66	66	or on behalf of subscribers toward the subscribers' 41
67	67	total contributions to cost -sharing requirements; 42
68	68	providing applicability; providing disclosure 43
69	69	requirements; amending s. 409.967, F.S.; conforming a 44
70	70	cross-reference; amending s. 641.185, F.S.; conforming 45
71	71	a provision to changes made by the act; providing a 46
72	72	declaration of important state interest; providing an 47
73	73	effective date. 48
74	74	49
75	75	Be It Enacted by the Legislature of the State of Florida: 50
76	76
77	77	HB 1063 2023
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82	82	hb1063-00
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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. Section 627.6383, Florida Statutes, is created 52
90	90	to read: 53
91	91	627.6383 Cost-sharing requirements. — 54
92	92	(1) As used in this section, the term "cost -sharing 55
93	93	requirement" means a dollar limit, a deductible, a copayment, 56
94	94	coinsurance, or any other out -of-pocket expense imposed on an 57
95	95	insured, including, but not limited to, the annual limitation on 58
96	96	cost sharing subject to 42 U.S.C. s. 18022. 59
97	97	(2)(a) Each health insurer issuing, delivering, or 60
98	98	renewing a policy in this state which provides prescription drug 61
99	99	coverage, or each pharmacy benefit manager on behalf of such 62
100	100	health insurer, shall apply any amount paid by an insured or by 63
101	101	another person on behalf of the insured toward the insured's 64
102	102	total contribution to any cost -sharing requirement. 65
103	103	(b) The amount paid by or on behalf of the insured which 66
104	104	is applied toward the insured's total contribution to any cost -67
105	105	sharing requirement under paragraph (a) includes, but is not 68
106	106	limited to, any payment with or any discount through financial 69
107	107	assistance, a manufacturer copay card, a product voucher, or any 70
108	108	other reduction in out -of-pocket expenses made by or on behalf 71
109	109	of the insured for a prescription drug. 72
110	110	(3) This section applies to any health insurance policy 73
111	111	issued, delivered, or renewed in this state on or after January 74
112	112	1, 2024. 75
113	113
114	114	HB 1063 2023
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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	Section 2. Present subsections (2) and (3) of section 76
126	126	627.6385, Florida Statutes, are redesignated as subsections (3) 77
127	127	and (4), respectively, a new subsection (2) is added to that 78
128	128	section, and present subsection (2) of that section is amended, 79
129	129	to read: 80
130	130	627.6385 Disclosures to policyholders; calculations of 81
131	131	cost sharing.— 82
132	132	(2) Each health insurer issuing, delivering, or renewing a 83
133	133	policy in this state which provides prescription drug coverage, 84
134	134	regardless of whether the prescription drug benefits are 85
135	135	administered or managed by the health insurer or by a pharmacy 86
136	136	benefit manager on behalf of the health insur er, shall disclose 87
137	137	on its website that any amount paid by a policyholder or by 88
138	138	another person on behalf of the policyholder must be applied 89
139	139	toward the policyholder's total contribution to any cost -sharing 90
140	140	requirement pursuant to s. 627.6383. This subsectio n applies to 91
141	141	any policy issued, delivered, or renewed in this state on or 92
142	142	after January 1, 2024. 93
143	143	(3)(2) Each health insurer shall include in every policy 94
144	144	delivered or issued for delivery to any person in this the state 95
145	145	or in materials provided as require d by s. 627.64725 a notice 96
146	146	that the information required by this section is available 97
147	147	electronically and the website address of the website where the 98
148	148	information can be accessed. In addition, each health insurer 99
149	149	issuing, delivering, or renewing a policy in this state which 100
150	150
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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
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160	160
161	161
162	162	provides prescription drug coverage, regardless of whether the 101
163	163	prescription drug benefits are administered or managed by the 102
164	164	health insurer or by a pharmacy benefit manager on behalf of the 103
165	165	health insurer, shall include in every policy th at is issued, 104
166	166	delivered, or renewed to any person in this state on or after 105
167	167	January 1, 2024, the disclosure that any amount paid by a 106
168	168	policyholder or by another person on behalf of the policyholder 107
169	169	must be applied toward the policyholder's total contributi on to 108
170	170	any cost-sharing requirement pursuant to s. 627.6383. 109
171	171	Section 3. Paragraph (c) is added to subsection (2) of 110
172	172	section 627.64741, Florida Statutes, to read: 111
173	173	627.64741 Pharmacy benefit manager contracts. — 112
174	174	(2) A contract between a health insurer and a pharmacy 113
175	175	benefit manager must require that the pharmacy benefit manager: 114
176	176	(c)1. Apply any amount paid by an insured or by another 115
177	177	person on behalf of the insured toward the insured's total 116
178	178	contribution to any cost -sharing requirement pursuant to s. 117
179	179	627.6383. This subparagraph applies to any insured whose 118
180	180	insurance policy is issued, delivered, or renewed in this state 119
181	181	on or after January 1, 2024. 120
182	182	2. Disclose to every insured whose insurance policy is 121
183	183	issued, delivered, or renewed in this state on or after January 122
184	184	1, 2024, that the pharmacy benefit manager shall apply any 123
185	185	amount paid by the insured or by another person on behalf of the 124
186	186	insured toward the insured's total contribution to any cost -125
187	187
188	188	HB 1063 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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197	197
198	198
199	199	sharing requirement pursuant to s. 627.6383. 126
200	200	Section 4. Section 627.65715, Florida Statutes, is created 127
201	201	to read: 128
202	202	627.65715 Cost-sharing requirements. — 129
203	203	(1) As used in this section, the term "cost -sharing 130
204	204	requirement" means a dollar limit, a deductible, a copayment, 131
205	205	coinsurance, or any other out -of-pocket expense imposed on an 132
206	206	insured, including, but not limited to, the annual limitation on 133
207	207	cost sharing subject to 42 U.S.C. s. 18022. 134
208	208	(2)(a) Each insurer issuing, delivering, or renewing a 135
209	209	policy in this state which provides prescription drug coverage, 136
210	210	or each pharmacy benefit manager on behalf of such insurer, 137
211	211	shall apply any amount paid by an insured or by another person 138
212	212	on behalf of the insured toward the insured's total contribution 139
213	213	to any cost-sharing requirement. 140
214	214	(b) The amount paid by or on behalf o f the insured which 141
215	215	is applied toward the insured's total contribution to any cost -142
216	216	sharing requirement under paragraph (a) includes, but is not 143
217	217	limited to, any payment with or any discount through financial 144
218	218	assistance, a manufacturer copay card, a product voucher, or any 145
219	219	other reduction in out -of-pocket expenses made by or on behalf 146
220	220	of the insured for a prescription drug. 147
221	221	(3) Each insurer issuing, delivering, or renewing a policy 148
222	222	in this state which provides prescription drug coverage, 149
223	223	regardless of whether the prescription drug benefits are 150
224	224
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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	administered or managed by the insurer or by a pharmacy benefit 151
237	237	manager on behalf of the insurer, shall disclose on its website 152
238	238	and in every policy issued, delivered, or renewed in this state 153
239	239	on or after January 1, 202 4, that any amount paid by an insured 154
240	240	or by another person on behalf of the insured must be applied 155
241	241	toward the insured's total contribution to any cost -sharing 156
242	242	requirement. 157
243	243	(4) This section applies to any group health insurance 158
244	244	policy issued, delivered, or renewed in this state on or after 159
245	245	January 1, 2024. 160
246	246	Section 5. Paragraph (c) is added to subsection (2) of 161
247	247	section 627.6572, Florida Statutes, to read: 162
248	248	627.6572 Pharmacy benefit manager contracts. — 163
249	249	(2) A contract between a health insurer and a ph armacy 164
250	250	benefit manager must require that the pharmacy benefit manager: 165
251	251	(c)1. Apply any amount paid by an insured or by another 166
252	252	person on behalf of the insured toward the insured's total 167
253	253	contribution to any cost -sharing requirement pursuant to s. 168
254	254	627.65715. This subparagraph applies to any insured whose 169
255	255	insurance policy is issued, delivered, or renewed in this state 170
256	256	on or after January 1, 2024. 171
257	257	2. Disclose to every insured whose insurance policy is 172
258	258	issued, delivered, or renewed in this state on or after January 173
259	259	1, 2024, that the pharmacy benefit manager shall apply any 174
260	260	amount paid by the insured or by another person on behalf of the 175
261	261
262	262	HB 1063 2023
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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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271	271
272	272
273	273	insured toward the insured's total contribution to any cost -176
274	274	sharing requirement pursuant to s. 627.65715. 177
275	275	Section 6. Paragraph (e) of subsection (5) of section 178
276	276	627.6699, Florida Statutes, is amended to read: 179
277	277	627.6699 Employee Health Care Access Act. — 180
278	278	(5) AVAILABILITY OF COVERAGE. — 181
279	279	(e) All health benefit plans issued under this section 182
280	280	must comply with the following co nditions: 183
281	281	1. For employers who have fewer than two employees, a late 184
282	282	enrollee may be excluded from coverage for no longer than 24 185
283	283	months if he or she was not covered by creditable coverage 186
284	284	continually to a date not more than 63 days before the effective 187
285	285	date of his or her new coverage. 188
286	286	2. Any requirement used by a small employer carrier in 189
287	287	determining whether to provide coverage to a small employer 190
288	288	group, including requirements for minimum participation of 191
289	289	eligible employees and minimum employer contrib utions, must be 192
290	290	applied uniformly among all small employer groups having the 193
291	291	same number of eligible employees applying for coverage or 194
292	292	receiving coverage from the small employer carrier, except that 195
293	293	a small employer carrier that participates in, administe rs, or 196
294	294	issues health benefits pursuant to s. 381.0406 which do not 197
295	295	include a preexisting condition exclusion may require as a 198
296	296	condition of offering such benefits that the employer has had no 199
297	297	health insurance coverage for its employees for a period of at 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
309	309
310	310	least 6 months. A small employer carrier may vary application of 201
311	311	minimum participation requirements and minimum employer 202
312	312	contribution requirements only by the size of the small employer 203
313	313	group. 204
314	314	3. In applying minimum participation requirements with 205
315	315	respect to a small employer, a small employer carrier may shall 206
316	316	not consider as an eligible employee employees or dependents who 207
317	317	have qualifying existing coverage in an employer -based group 208
318	318	insurance plan or an ERISA qualified self -insurance plan in 209
319	319	determining whether the applicable percentage of participation 210
320	320	is met. However, a small employer carrier may count eligible 211
321	321	employees and dependents who have coverage under another health 212
322	322	plan that is sponsored by that employer. 213
323	323	4. A small employer carrier may shall not increase any 214
324	324	requirement for minimum employee participation or any 215
325	325	requirement for minimum employer contribution applicable to a 216
326	326	small employer at any time after the small employer has been 217
327	327	accepted for coverage, unless the employer size has changed, in 218
328	328	which case the small employer carrier may apply the requirements 219
329	329	that are applicable to the new group size. 220
330	330	5. If a small employer carrier offers coverage to a small 221
331	331	employer, it must offer coverage to all the small employer's 222
332	332	eligible employees and the ir dependents. A small employer 223
333	333	carrier may not offer coverage limited to certain persons in a 224
334	334	group or to part of a group, except with respect to late 225
335	335
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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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345	345
346	346
347	347	enrollees. 226
348	348	6. A small employer carrier may not modify any health 227
349	349	benefit plan issued to a small employ er with respect to a small 228
350	350	employer or any eligible employee or dependent through riders, 229
351	351	endorsements, or otherwise to restrict or exclude coverage for 230
352	352	certain diseases or medical conditions otherwise covered by the 231
353	353	health benefit plan. 232
354	354	7. An initial enrollment period of at least 30 days must 233
355	355	be provided. An annual 30 -day open enrollment period must be 234
356	356	offered to each small employer's eligible employees and their 235
357	357	dependents. A small employer carrier must provide special 236
358	358	enrollment periods as required by s. 627.65615. 237
359	359	8. A small employer carrier shall comply with s. 627.65715 238
360	360	with respect to contribution to cost -sharing requirements, as 239
361	361	defined in that section. 240
362	362	Section 7. Subsection (48) is added to section 641.31, 241
363	363	Florida Statutes, to read: 242
364	364	641.31 Health maintenance contracts. — 243
365	365	(48)(a) As used in this subsection, the term "cost -sharing 244
366	366	requirement" means a dollar limit, a deductible, a copayment, 245
367	367	coinsurance, or any other out -of-pocket expense imposed on a 246
368	368	subscriber, including, but not limited t o, the annual limitation 247
369	369	on cost sharing subject to 42 U.S.C. s. 18022. 248
370	370	(b)1. Each health maintenance organization issuing, 249
371	371	delivering, or renewing a health maintenance contract or 250
372	372
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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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382	382
383	383
384	384	certificate in this state which provides prescription drug 251
385	385	coverage, or each pharmacy benefit manager on behalf of such 252
386	386	health maintenance organization, shall apply any amount paid by 253
387	387	a subscriber or by another person on behalf of the subscriber 254
388	388	toward the subscriber's total contribution to any cost -sharing 255
389	389	requirement. 256
390	390	2. The amount paid by or on behalf of the subscriber which 257
391	391	is applied toward the subscriber's total contribution to any 258
392	392	cost-sharing requirement under subparagraph 1. includes, but is 259
393	393	not limited to, any payment with or any discount through 260
394	394	financial assistance, a manufacturer copay card, a product 261
395	395	voucher, or any other reduction in out -of-pocket expenses made 262
396	396	by or on behalf of the subscriber for a prescription drug. 263
397	397	(c) Each health maintenance organization issuing, 264
398	398	delivering, or renewing a health maintenan ce contract or 265
399	399	certificate in this state which provides prescription drug 266
400	400	coverage, regardless of whether the prescription drug benefits 267
401	401	are administered or managed by the health maintenance 268
402	402	organization or by a pharmacy benefit manager on behalf of the 269
403	403	health maintenance organization, shall disclose on its website 270
404	404	and in every subscriber's health maintenance contract, 271
405	405	certificate, or member handbook issued, delivered, or renewed in 272
406	406	this state on or after January 1, 2024, that any amount paid by 273
407	407	a subscriber or by another person on behalf of the subscriber 274
408	408	must be applied toward the subscriber's total contribution to 275
409	409
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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	any cost-sharing requirement. 276
422	422	(d) This subsection applies to any health maintenance 277
423	423	contract or certificate issued, delivered, or renewed in this 278
424	424	state on or after January 1, 2024. 279
425	425	Section 8. Paragraph (c) is added to subsection (2) of 280
426	426	section 641.314, Florida Statutes, to read: 281
427	427	641.314 Pharmacy benefit manager contracts. — 282
428	428	(2) A contract between a health maintenance organization 283
429	429	and a pharmacy benefit manager must require that the pharmacy 284
430	430	benefit manager: 285
431	431	(c)1. Apply any amount paid by a subscriber or by another 286
432	432	person on behalf of the subscriber toward the subscriber's total 287
433	433	contribution to any cost -sharing requirement pursuant to s. 288
434	434	641.31(48). This subparagraph applies to any subscriber whose 289
435	435	health maintenance contract or certificate is issued, delivered, 290
436	436	or renewed in this state on or after January 1, 2024. 291
437	437	2. Disclose to every subscriber whose health maintenance 292
438	438	contract or certificate is issued, delivered, or renewed in this 293
439	439	state on or after January 1, 2024, that the pharmacy benefit 294
440	440	manager shall apply any amount paid by the subscriber or by 295
441	441	another person on behalf of the subscriber toward the 296
442	442	subscriber's total contribution to any cost-sharing requirement 297
443	443	pursuant to s. 641.31(48). 298
444	444	Section 9. Paragraph (o) of subsection (2) of section 299
445	445	409.967, Florida Statutes, is amended to read: 300
446	446
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454	454	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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457	457
458	458	409.967 Managed care plan accountability. — 301
459	459	(2) The agency shall establish such contract requirements 302
460	460	as are necessary for the operation of the statewide managed care 303
461	461	program. In addition to any other provisions the agency may deem 304
462	462	necessary, the contract must require: 305
463	463	(o) Transparency.—Managed care plans shall comply with ss. 306
464	464	627.6385(4) and 641.54(7) ss. 627.6385(3) and 641.54(7) . 307
465	465	Section 10. Paragraph (k) of subsection (1) of section 308
466	466	641.185, Florida Statutes, is amended to read: 309
467	467	641.185 Health maintenance organization subscriber 310
468	468	protections.— 311
469	469	(1) With respect to the provisions of this part and part 312
470	470	III, the principles expressed in the following statements serve 313
471	471	as standards to be followed by the commission, the office, the 314
472	472	department, and the Agency for Health Care Administration in 315
473	473	exercising their powers and duties, in exercisin g administrative 316
474	474	discretion, in administrative interpretations of the law, in 317
475	475	enforcing its provisions, and in adopting rules: 318
476	476	(k) A health maintenance organization subscriber shall be 319
477	477	given a copy of the applicable health maintenance contract, 320
478	478	certificate, or member handbook specifying: all the provisions, 321
479	479	disclosure, and limitations required pursuant to s. 641.31(1) , 322
480	480	and (4), and (48); the covered services, including those 323
481	481	services, medical conditions, and provider types specified in 324
482	482	ss. 641.31, 641.31094, 641.31095, 641.31096, 641.51(11), and 325
483	483
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491	491	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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494	494
495	495	641.513; and where and in what manner services may be obtained 326
496	496	pursuant to s. 641.31(4). 327
497	497	Section 11. The Legislature finds that this act fulfills 328
498	498	an important state interest. 329
499	499	Section 12. This act shall take effect July 1, 2023. 330