Florida 2024 Regular Session

Florida House Bill H0491 Compare Versions

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

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3	3	HB 491 2024
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7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb0491-00
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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 access to appropriate medication 2
16	16	for serious mental illness; amending s. 409.901, F.S.; 3
17	17	defining the term "serious mental illness"; amending 4
18	18	s. 409.912, F.S.; requiring the Agency for Health Care 5
19	19	Administration to approve drug products for Medicaid 6
20	20	recipients for the treatment of serious mental illness 7
21	21	without step-therapy prior authorization under certain 8
22	22	circumstances; amending s. 409.910, F. S.; conforming a 9
23	23	cross-reference; directing the agency to include the 10
24	24	rate impact of this act in certain program rates that 11
25	25	become effective on a date certain; providing an 12
26	26	effective date. 13
27	27	14
28	28	Be It Enacted by the Legislature of the State of Florida: 15
29	29	16
30	30	Section 1. Subsections (27) and (28) of section 409.901, 17
31	31	Florida Statutes, are renumbered as subsections (28) and (29), 18
32	32	respectively, and a new subsection (27) is added to that 19
33	33	section, to read: 20
34	34	409.901 Definitions; ss. 409.901 -409.920.—As used in ss. 21
35	35	409.901-409.920, except as otherwise specifically provided, the 22
36	36	term: 23
37	37	(27) "Serious mental illness" means any of the following 24
38	38	psychiatric disorders as defined by the American Psychiatric 25
39	39
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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	Association in the Diagnostic and Statistical Manual of Mental 26
52	52	Disorders, Fifth Edition: 27
53	53	(a) Bipolar disorder, including hypomanic, manic, 28
54	54	depressive, and mixed -feature episodes. 29
55	55	(b) Depression in childhood or adolescence. 30
56	56	(c) Major depressive disorders, including single and 31
57	57	recurrent depressive episodes. 32
58	58	(d) Obsessive-compulsive disorder. 33
59	59	(e) Paranoid personality disorder or other psychotic 34
60	60	disorders. 35
61	61	(f) Schizoaffective disorder, including bipolar or 36
62	62	depressive symptoms. 37
63	63	(g) Schizophrenia. 38
64	64	Section 2. Paragraph (a) of subsection (5) of section 39
65	65	409.912, Florida Statutes, is amended to read: 40
66	66	409.912 Cost-effective purchasing of health care. —The 41
67	67	agency shall purchase goods and services for Medicaid recipients 42
68	68	in the most cost-effective manner consistent with the delivery 43
69	69	of quality medical care. To ensure that medical services are 44
70	70	effectively utilized, the agency may, in any case, require a 45
71	71	confirmation or second physician's opinion of the correct 46
72	72	diagnosis for purposes of authorizing future services under the 47
73	73	Medicaid program. This section does not restric t access to 48
74	74	emergency services or poststabilization care services as defined 49
75	75	in 42 C.F.R. s. 438.114. Such confirmation or second opinion 50
76	76
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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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86	86
87	87
88	88	shall be rendered in a manner approved by the agency. The agency 51
89	89	shall maximize the use of prepaid per capita and prep aid 52
90	90	aggregate fixed-sum basis services when appropriate and other 53
91	91	alternative service delivery and reimbursement methodologies, 54
92	92	including competitive bidding pursuant to s. 287.057, designed 55
93	93	to facilitate the cost -effective purchase of a case -managed 56
94	94	continuum of care. The agency shall also require providers to 57
95	95	minimize the exposure of recipients to the need for acute 58
96	96	inpatient, custodial, and other institutional care and the 59
97	97	inappropriate or unnecessary use of high -cost services. The 60
98	98	agency shall contract with a vendor to monitor and evaluate the 61
99	99	clinical practice patterns of providers in order to identify 62
100	100	trends that are outside the normal practice patterns of a 63
101	101	provider's professional peers or the national guidelines of a 64
102	102	provider's professional associati on. The vendor must be able to 65
103	103	provide information and counseling to a provider whose practice 66
104	104	patterns are outside the norms, in consultation with the agency, 67
105	105	to improve patient care and reduce inappropriate utilization. 68
106	106	The agency may mandate prior autho rization, drug therapy 69
107	107	management, or disease management participation for certain 70
108	108	populations of Medicaid beneficiaries, certain drug classes, or 71
109	109	particular drugs to prevent fraud, abuse, overuse, and possible 72
110	110	dangerous drug interactions. The Pharmaceutic al and Therapeutics 73
111	111	Committee shall make recommendations to the agency on drugs for 74
112	112	which prior authorization is required. The agency shall inform 75
113	113
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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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123	123
124	124
125	125	the Pharmaceutical and Therapeutics Committee of its decisions 76
126	126	regarding drugs subject to prior authorization . The agency is 77
127	127	authorized to limit the entities it contracts with or enrolls as 78
128	128	Medicaid providers by developing a provider network through 79
129	129	provider credentialing. The agency may competitively bid single -80
130	130	source-provider contracts if procurement of goods o r services 81
131	131	results in demonstrated cost savings to the state without 82
132	132	limiting access to care. The agency may limit its network based 83
133	133	on the assessment of beneficiary access to care, provider 84
134	134	availability, provider quality standards, time and distance 85
135	135	standards for access to care, the cultural competence of the 86
136	136	provider network, demographic characteristics of Medicaid 87
137	137	beneficiaries, practice and provider -to-beneficiary standards, 88
138	138	appointment wait times, beneficiary use of services, provider 89
139	139	turnover, provider profiling, provider licensure history, 90
140	140	previous program integrity investigations and findings, peer 91
141	141	review, provider Medicaid policy and billing compliance records, 92
142	142	clinical and medical record audits, and other factors. Providers 93
143	143	are not entitled to enro llment in the Medicaid provider network. 94
144	144	The agency shall determine instances in which allowing Medicaid 95
145	145	beneficiaries to purchase durable medical equipment and other 96
146	146	goods is less expensive to the Medicaid program than long -term 97
147	147	rental of the equipment or goods. The agency may establish rules 98
148	148	to facilitate purchases in lieu of long -term rentals in order to 99
149	149	protect against fraud and abuse in the Medicaid program as 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	defined in s. 409.913. The agency may seek federal waivers 101
163	163	necessary to administer these poli cies. 102
164	164	(5)(a) The agency shall implement a Medicaid prescribed -103
165	165	drug spending-control program that includes the following 104
166	166	components: 105
167	167	1. A Medicaid preferred drug list, which shall be a 106
168	168	listing of cost-effective therapeutic options recommended by the 107
169	169	Medicaid Pharmacy and Therapeutics Committee established 108
170	170	pursuant to s. 409.91195 and adopted by the agency for each 109
171	171	therapeutic class on the preferred drug list. At the discretion 110
172	172	of the committee, and when feasible, the preferred drug list 111
173	173	should include at least two products in a therapeutic class. The 112
174	174	agency may post the preferred drug list and updates to the list 113
175	175	on an Internet website without following the rulemaking 114
176	176	procedures of chapter 120. Antiretroviral agents are excluded 115
177	177	from the preferred drug list. The agency shall also limit the 116
178	178	amount of a prescribed drug dispensed to no more than a 34 -day 117
179	179	supply unless the drug products' sma llest marketed package is 118
180	180	greater than a 34-day supply, or the drug is determined by the 119
181	181	agency to be a maintenance drug in which case a 100 -day maximum 120
182	182	supply may be authorized. The agency may seek any federal 121
183	183	waivers necessary to implement these cost -control programs and 122
184	184	to continue participation in the federal Medicaid rebate 123
185	185	program, or alternatively to negotiate state -only manufacturer 124
186	186	rebates. The agency may adopt rules to administer this 125
187	187
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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	subparagraph. The agency shall continue to provide unlimited 126
200	200	contraceptive drugs and items. The agency must establish 127
201	201	procedures to ensure that: 128
202	202	a. There is a response to a request for prior 129
203	203	authorization by telephone or other telecommunication device 130
204	204	within 24 hours after receipt of a request for prior 131
205	205	authorization; and 132
206	206	b. A 72-hour supply of the drug prescribed is provided in 133
207	207	an emergency or when the agency does not provide a response 134
208	208	within 24 hours as required by sub -subparagraph a. 135
209	209	2. A provider of prescribed drugs is reimbursed in an 136
210	210	amount not to exceed t he lesser of the actual acquisition cost 137
211	211	based on the Centers for Medicare and Medicaid Services National 138
212	212	Average Drug Acquisition Cost pricing files plus a professional 139
213	213	dispensing fee, the wholesale acquisition cost plus a 140
214	214	professional dispensing fee, the state maximum allowable cost 141
215	215	plus a professional dispensing fee, or the usual and customary 142
216	216	charge billed by the provider. 143
217	217	3. The agency shall develop and implement a process for 144
218	218	managing the drug therapies of Medicaid recipients who are using 145
219	219	significant numbers of prescribed drugs each month. The 146
220	220	management process may include, but is not limited to, 147
221	221	comprehensive, physician -directed medical-record reviews, claims 148
222	222	analyses, and case evaluations to determine the medical 149
223	223	necessity and appropriateness of a patient's treatment plan and 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
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236	236	drug therapies. The agency may contract with a private 151
237	237	organization to provide drug -program-management services. The 152
238	238	Medicaid drug benefit management program shall include 153
239	239	initiatives to manage drug therapies for HIV/AIDS pat ients, 154
240	240	patients using 20 or more unique prescriptions in a 180 -day 155
241	241	period, and the top 1,000 patients in annual spending. The 156
242	242	agency shall enroll any Medicaid recipient in the drug benefit 157
243	243	management program if he or she meets the specifications of this 158
244	244	provision and is not enrolled in a Medicaid health maintenance 159
245	245	organization. 160
246	246	4. The agency may limit the size of its pharmacy network 161
247	247	based on need, competitive bidding, price negotiations, 162
248	248	credentialing, or similar criteria. The agency shall give 163
249	249	special consideration to rural areas in determining the size and 164
250	250	location of pharmacies included in the Medicaid pharmacy 165
251	251	network. A pharmacy credentialing process may include criteria 166
252	252	such as a pharmacy's full -service status, location, size, 167
253	253	patient educational p rograms, patient consultation, disease 168
254	254	management services, and other characteristics. The agency may 169
255	255	impose a moratorium on Medicaid pharmacy enrollment if it is 170
256	256	determined that it has a sufficient number of Medicaid -171
257	257	participating providers. The agency mu st allow dispensing 172
258	258	practitioners to participate as a part of the Medicaid pharmacy 173
259	259	network regardless of the practitioner's proximity to any other 174
260	260	entity that is dispensing prescription drugs under the Medicaid 175
261	261
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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	program. A dispensing practitioner must meet all credentialing 176
274	274	requirements applicable to his or her practice, as determined by 177
275	275	the agency. 178
276	276	5. The agency shall develop and implement a program that 179
277	277	requires Medicaid practitioners who issue written prescriptions 180
278	278	for medicinal drugs to use a counterf eit-proof prescription pad 181
279	279	for Medicaid prescriptions. The agency shall require the use of 182
280	280	standardized counterfeit -proof prescription pads by prescribers 183
281	281	who issue written prescriptions for Medicaid recipients. The 184
282	282	agency may implement the program in targ eted geographic areas or 185
283	283	statewide. 186
284	284	6. The agency may enter into arrangements that require 187
285	285	manufacturers of generic drugs prescribed to Medicaid recipients 188
286	286	to provide rebates of at least 15.1 percent of the average 189
287	287	manufacturer price for the manufacturer 's generic products. 190
288	288	These arrangements must shall require that if a generic -drug 191
289	289	manufacturer pays federal rebates for Medicaid -reimbursed drugs 192
290	290	at a level below 15.1 percent, the manufacturer must provide a 193
291	291	supplemental rebate to the state in an amount n ecessary to 194
292	292	achieve a 15.1-percent rebate level. 195
293	293	7. The agency may establish a preferred drug list as 196
294	294	described in this subsection, and, pursuant to the establishment 197
295	295	of such preferred drug list, negotiate supplemental rebates from 198
296	296	manufacturers that are in addition to those required by Title 199
297	297	XIX of the Social Security Act and at no less than 14 percent of 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 average manufacturer price as defined in 42 U.S.C. s. 1936 201
311	311	on the last day of a quarter unless the federal or supplemental 202
312	312	rebate, or both, equals or exceeds 29 percent. There is no upper 203
313	313	limit on the supplemental rebates the agency may negotiate. The 204
314	314	agency may determine that specific products, brand -name or 205
315	315	generic, are competitive at lower rebate percentages. Agreement 206
316	316	to pay the minimum supplemen tal rebate percentage guarantees a 207
317	317	manufacturer that the Medicaid Pharmaceutical and Therapeutics 208
318	318	Committee will consider a product for inclusion on the preferred 209
319	319	drug list. However, a pharmaceutical manufacturer is not 210
320	320	guaranteed placement on the preferre d drug list by simply paying 211
321	321	the minimum supplemental rebate. Agency decisions will be made 212
322	322	on the clinical efficacy of a drug and recommendations of the 213
323	323	Medicaid Pharmaceutical and Therapeutics Committee, as well as 214
324	324	the price of competing products minus f ederal and state rebates. 215
325	325	The agency may contract with an outside agency or contractor to 216
326	326	conduct negotiations for supplemental rebates. For the purposes 217
327	327	of this section, the term "supplemental rebates" means cash 218
328	328	rebates. Value-added programs as a substit ution for supplemental 219
329	329	rebates are prohibited. The agency may seek any federal waivers 220
330	330	to implement this initiative. 221
331	331	8.a. The agency may implement a Medicaid behavioral drug 222
332	332	management system. The agency may contract with a vendor that 223
333	333	has experience in operating behavioral drug management systems 224
334	334	to implement this program. The agency may seek federal waivers 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
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347	347	to implement this program. 226
348	348	b. The agency, in conjunction with the Department of 227
349	349	Children and Families, may implement the Medicaid behavioral 228
350	350	drug management system that is designed to improve the quality 229
351	351	of care and behavioral health prescribing practices based on 230
352	352	best practice guidelines, improve patient adherence to 231
353	353	medication plans, reduce clinical risk, and lower prescribed 232
354	354	drug costs and the ra te of inappropriate spending on Medicaid 233
355	355	behavioral drugs. The program may include the following 234
356	356	elements: 235
357	357	(I) Provide for the development and adoption of best 236
358	358	practice guidelines for behavioral health -related drugs such as 237
359	359	antipsychotics, antidepressant s, and medications for treating 238
360	360	bipolar disorders and other behavioral conditions; translate 239
361	361	them into practice; review behavioral health prescribers and 240
362	362	compare their prescribing patterns to a number of indicators 241
363	363	that are based on national standards; and determine deviations 242
364	364	from best practice guidelines. 243
365	365	(II) Implement processes for providing feedback to and 244
366	366	educating prescribers using best practice educational materials 245
367	367	and peer-to-peer consultation. 246
368	368	(III) Assess Medicaid beneficiaries who are outli ers in 247
369	369	their use of behavioral health drugs with regard to the numbers 248
370	370	and types of drugs taken, drug dosages, combination drug 249
371	371	therapies, and other indicators of improper use of behavioral 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	health drugs. 251
385	385	(IV) Alert prescribers to patients who fail to ref ill 252
386	386	prescriptions in a timely fashion, are prescribed multiple same -253
387	387	class behavioral health drugs, and may have other potential 254
388	388	medication problems. 255
389	389	(V) Track spending trends for behavioral health drugs and 256
390	390	deviation from best practice guidelines. 257
391	391	(VI) Use educational and technological approaches to 258
392	392	promote best practices, educate consumers, and train prescribers 259
393	393	in the use of practice guidelines. 260
394	394	(VII) Disseminate electronic and published materials. 261
395	395	(VIII) Hold statewide and regional conferences. 262
396	396	(IX) Implement a disease management program with a model 263
397	397	quality-based medication component for severely mentally ill 264
398	398	individuals and emotionally disturbed children who are high 265
399	399	users of care. 266
400	400	9. The agency shall implement a Medicaid prescription drug 267
401	401	management system. 268
402	402	a. The agency may contract with a vendor that has 269
403	403	experience in operating prescription drug management systems in 270
404	404	order to implement this system. Any management system that is 271
405	405	implemented in accordance with this subparagraph must rely o n 272
406	406	cooperation between physicians and pharmacists to determine 273
407	407	appropriate practice patterns and clinical guidelines to improve 274
408	408	the prescribing, dispensing, and use of drugs in the Medicaid 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	program. The agency may seek federal waivers to implement this 276
422	422	program. 277
423	423	b. The drug management system must be designed to improve 278
424	424	the quality of care and prescribing practices based on best 279
425	425	practice guidelines, improve patient adherence to medication 280
426	426	plans, reduce clinical risk, and lower prescribed drug costs and 281
427	427	the rate of inappropriate spending on Medicaid prescription 282
428	428	drugs. The program must: 283
429	429	(I) Provide for the adoption of best practice guidelines 284
430	430	for the prescribing and use of drugs in the Medicaid program, 285
431	431	including translating best practice guidelines into pra ctice; 286
432	432	reviewing prescriber patterns and comparing them to indicators 287
433	433	that are based on national standards and practice patterns of 288
434	434	clinical peers in their community, statewide, and nationally; 289
435	435	and determine deviations from best practice guidelines. 290
436	436	(II) Implement processes for providing feedback to and 291
437	437	educating prescribers using best practice educational materials 292
438	438	and peer-to-peer consultation. 293
439	439	(III) Assess Medicaid recipients who are outliers in their 294
440	440	use of a single or multiple prescription drugs wi th regard to 295
441	441	the numbers and types of drugs taken, drug dosages, combination 296
442	442	drug therapies, and other indicators of improper use of 297
443	443	prescription drugs. 298
444	444	(IV) Alert prescribers to recipients who fail to refill 299
445	445	prescriptions in a timely fashion, are prescr ibed multiple drugs 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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456	456
457	457
458	458	that may be redundant or contraindicated, or may have other 301
459	459	potential medication problems. 302
460	460	10. The agency may contract for drug rebate 303
461	461	administration, including, but not limited to, calculating 304
462	462	rebate amounts, invoicing manufacturers, negotiating disputes 305
463	463	with manufacturers, and maintaining a database of rebate 306
464	464	collections. 307
465	465	11. The agency may specify the preferred daily dosing form 308
466	466	or strength for the purpose of promoting best practices with 309
467	467	regard to the prescribing of certain drugs as specified in the 310
468	468	General Appropriations Act and ensuring cost -effective 311
469	469	prescribing practices. 312
470	470	12. The agency may require prior authorization for 313
471	471	Medicaid-covered prescribed drugs. The agency may prior -314
472	472	authorize the use of a product: 315
473	473	a. For an indication not approved in labeling; 316
474	474	b. To comply with certain clinical guidelines; or 317
475	475	c. If the product has the potential for overuse, misuse, 318
476	476	or abuse. 319
477	477	320
478	478	The agency may require the prescribing professional to provide 321
479	479	information about the rationale and su pporting medical evidence 322
480	480	for the use of a drug. The agency shall post prior 323
481	481	authorization, step-edit criteria and protocol, and updates to 324
482	482	the list of drugs that are subject to prior authorization on the 325
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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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493	493
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495	495	agency's Internet website within 21 days after the prior 326
496	496	authorization and step -edit criteria and protocol and updates 327
497	497	are approved by the agency. For purposes of this subparagraph, 328
498	498	the term "step-edit" means an automatic electronic review of 329
499	499	certain medications subject to prior authorization. 330
500	500	13. The agency, in conjunction with the Pharmaceutical and 331
501	501	Therapeutics Committee, may require age -related prior 332
502	502	authorizations for certain prescribed drugs. The agency may 333
503	503	preauthorize the use of a drug for a recipient who may not meet 334
504	504	the age requirement or may ex ceed the length of therapy for use 335
505	505	of this product as recommended by the manufacturer and approved 336
506	506	by the Food and Drug Administration. Prior authorization may 337
507	507	require the prescribing professional to provide information 338
508	508	about the rationale and supporting m edical evidence for the use 339
509	509	of a drug. 340
510	510	14. The agency shall implement a step -therapy prior 341
511	511	authorization approval process for medications excluded from the 342
512	512	preferred drug list. Medications listed on the preferred drug 343
513	513	list must be used within the previou s 12 months before the 344
514	514	alternative medications that are not listed. The step -therapy 345
515	515	prior authorization may require the prescriber to use the 346
516	516	medications of a similar drug class or for a similar medical 347
517	517	indication unless contraindicated in the Food and Dr ug 348
518	518	Administration labeling. The trial period between the specified 349
519	519	steps may vary according to the medical indication. The step -350
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528	528	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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532	532	therapy approval process must shall be developed in accordance 351
533	533	with the committee as stated in s. 409.91195(7) and (8). A drug 352
534	534	product may be approved or, in the case of a drug product for 353
535	535	the treatment of a serious mental illness, must be approved 354
536	536	without meeting the step -therapy prior authorization criteria if 355
537	537	the prescribing physician provides the agency with additional 356
538	538	written medical or clinical documentation that the product is 357
539	539	medically necessary because: 358
540	540	a. There is not a drug on the preferred drug list to treat 359
541	541	the disease or medical condition which is an acceptable clinical 360
542	542	alternative; 361
543	543	b. The alternatives have been in effective in the treatment 362
544	544	of the beneficiary's disease; 363
545	545	c. The drug product or medication of a similar drug class 364
546	546	is prescribed for the treatment of a serious mental illness 365
547	547	schizophrenia or schizotypal or delusional disorders ; prior 366
548	548	authorization has been granted previously for the prescribed 367
549	549	drug; and the medication was dispensed to the patient during the 368
550	550	previous 12 months; or 369
551	551	d. Based on historical evidence and known characteristics 370
552	552	of the patient and the drug, the drug is likely to be 371
553	553	ineffective, or the number of doses have been ineffective. 372
554	554	373
555	555	The agency shall work with the physician to determine the best 374
556	556	alternative for the patient. The agency may adopt rules waiving 375
557	557
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567	567
568	568
569	569	the requirements for written clinical documentation for specific 376
570	570	drugs in limited clinical situations. 377
571	571	15. The agency shall implement a return and reuse program 378
572	572	for drugs dispensed by pharmacies to institutional recipients, 379
573	573	which includes payment of a $5 restocking fee for the 380
574	574	implementation and operation of the program. The return a nd 381
575	575	reuse program shall be implemented electronically and in a 382
576	576	manner that promotes efficiency. The program must permit a 383
577	577	pharmacy to exclude drugs from the program if it is not 384
578	578	practical or cost-effective for the drug to be included and must 385
579	579	provide for the return to inventory of drugs that cannot be 386
580	580	credited or returned in a cost -effective manner. The agency 387
581	581	shall determine if the program has reduced the amount of 388
582	582	Medicaid prescription drugs which are destroyed on an annual 389
583	583	basis and if there are additiona l ways to ensure more 390
584	584	prescription drugs are not destroyed which could safely be 391
585	585	reused. 392
586	586	Section 3. Paragraph (a) of subsection (20) of section 393
587	587	409.910, Florida Statutes, is amended to read: 394
588	588	409.910 Responsibility for payments on behalf of Medicaid -395
589	589	eligible persons when other parties are liable. — 396
590	590	(20)(a) Entities providing health insurance as defined in 397
591	591	s. 624.603, health maintenance organizations and prepaid health 398
592	592	clinics as defined in chapter 641, and, on behalf of their 399
593	593	clients, third-party administrators, pharmacy benefits managers, 400
594	594
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605	605
606	606	and any other third parties, as defined in s. 409.901 s. 401
607	607	409.901(27), which are legally responsible for payment of a 402
608	608	claim for a health care item or service as a condition of doing 403
609	609	business in the state or providing coverage to residents of the 404
610	610	this state, shall provide such records and information as are 405
611	611	necessary to accomplish the purpose of this section, unless such 406
612	612	requirement results in an unreasonable burden. 407
613	613	Section 4. The Agency for Health Care Administrat ion is 408
614	614	directed to include the rate impact of this act in the Medicaid 409
615	615	managed medical assistance program and long -term care managed 410
616	616	care program rates that become effective on October 1, 2024. 411
617	617	Section 5. This act shall take effect October 1, 2024. 412