Florida 2025 Regular Session

Florida House Bill H0941 Compare Versions

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

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10	10	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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14	14	A bill to be entitled 1
15	15	An act relating to pharmacist selection and 2
16	16	reimbursement; creating ss. 110.12305, 409.91193, 3
17	17	409.9773, 627.64743, 627.65723, and 641.3143, F.S.; 4
18	18	authorizing health plan members and covered 5
19	19	individuals under the state group insurance program 6
20	20	plans and health maintenance organizations, Medicaid 7
21	21	recipients under the Medicaid managed care plans and 8
22	22	Medicaid providers, Medicaid managed care enrollees 9
23	23	under eligible plans contracted with the Agency for 10
24	24	Health Care Administration for the Medicaid program, 11
25	25	insureds and covered individuals under individual 12
26	26	health insurance policies, insureds and covered 13
27	27	individuals under group, blanket, and franchise health 14
28	28	insurance policies, and subscribers and covered 15
29	29	individuals under health maintenance contracts, 16
30	30	respectively, to select in -network pharmacists for 17
31	31	services under certain circumstances; prohibiting 18
32	32	reimbursement to in-network pharmacists from being 19
33	33	denied under specifi ed circumstances; providing that 20
34	34	licensed pharmacists may count toward network adequacy 21
35	35	standards for access to services within the scope of 22
36	36	practice of pharmacists; providing construction; 23
37	37	providing an effective date. 24
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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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51	51	Be It Enacted by the Legislature of the State of Florida: 26
52	52	27
53	53	Section 1. Section 110.12305, Florida Statutes, is created 28
54	54	to read: 29
55	55	110.12305 Pharmacist selection and reimbursement. — 30
56	56	(1)(a) A health plan member or covered individual may 31
57	57	select an in-network pharmacist for any service covered by the 32
58	58	state group health insurance plan, state -contracted HMO, or any 33
59	59	other insurance plan under the state group insurance program 34
60	60	which is within the scope of practice of a pharmacist licensed 35
61	61	under chapter 465. 36
62	62	(b) Reimbursement to an in -network pharmacist may not be 37
63	63	denied for the provision of a service that is within the scope 38
64	64	of practice of a pharmacist licensed under chapter 465 if the 39
65	65	service, when provided by an allopathic physician licensed under 40
66	66	chapter 458, an osteopathic physician lic ensed under chapter 41
67	67	459, a physician assistant licensed under chapter 458 or chapter 42
68	68	459, or an advanced practice registered nurse licensed under 43
69	69	chapter 464, is covered by the state group health insurance 44
70	70	plan, health maintenance contract, or any other in surance plan 45
71	71	under the state group insurance program. 46
72	72	(2)(a) Pharmacists licensed under chapter 465 may count 47
73	73	toward network adequacy standards for provider access to 48
74	74	services provided within the scope of practice of pharmacists. 49
75	75	(b) The participation of pharmacies in the network's drug 50
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81	81	CODING: Words stricken are deletions; words underlined are additions.
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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	benefits does not satisfy the requirement of paragraph (a). 51
89	89	Section 2. Section 409.91193, Florida Statutes, is created 52
90	90	to read: 53
91	91	409.91193 Pharmacist selection and reimbursement. — 54
92	92	(1)(a) A Medicaid recipient may s elect an in-network 55
93	93	pharmacist for any service covered by the managed care plan or 56
94	94	Medicaid provider which is within the scope of practice of a 57
95	95	pharmacist licensed under chapter 465. 58
96	96	(b) Reimbursement to an in -network pharmacist may not be 59
97	97	denied for the provision of a service that is within the scope 60
98	98	of practice of a pharmacist licensed under chapter 465 if the 61
99	99	service, when provided by an allopathic physician licensed under 62
100	100	chapter 458, an osteopathic physician licensed under chapter 63
101	101	459, a physician assistant licensed under chapter 458 or chapter 64
102	102	459, or an advanced practice registered nurse licensed under 65
103	103	chapter 464, is covered by the managed care plan or Medicaid 66
104	104	provider. 67
105	105	(2)(a) Pharmacists licensed under chapter 465 may count 68
106	106	toward network adequ acy standards for provider access to 69
107	107	services provided within the scope of practice of pharmacists.70
108	108	(b) The participation of pharmacies in the network's drug 71
109	109	benefits does not satisfy the requirement of paragraph (a). 72
110	110	Section 3. Section 409.9773, Flor ida Statutes, is created 73
111	111	to read: 74
112	112	409.9773 Pharmacist selection and reimbursement. — 75
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125	125	(1)(a) A Medicaid managed care enrollee may select an in -76
126	126	network pharmacist for any service covered by the managed care 77
127	127	plan which is within the scope of practice of a pharmacist 78
128	128	licensed under chapter 465. 79
129	129	(b) Reimbursement to an in -network pharmacist may not be 80
130	130	denied for the provision of a service that is within the scope 81
131	131	of practice of a pharmacist licensed under chapter 465 if the 82
132	132	service, when provided by an allo pathic physician licensed under 83
133	133	chapter 458, an osteopathic physician licensed under chapter 84
134	134	459, a physician assistant licensed under chapter 458 or chapter 85
135	135	459, or an advanced practice registered nurse licensed under 86
136	136	chapter 464, is covered by the manage d care plan. 87
137	137	(2)(a) Pharmacists licensed under chapter 465 may count 88
138	138	toward network adequacy standards for provider access to 89
139	139	services provided within the scope of practice of pharmacists. 90
140	140	(b) The participation of pharmacies in the network's drug 91
141	141	benefits does not satisfy the requirement of paragraph (a). 92
142	142	Section 4. Section 627.64743, Florida Statutes, is created 93
143	143	to read: 94
144	144	627.64743 Pharmacist selection and reimbursement. — 95
145	145	(1)(a) An insured or covered individual may select an in -96
146	146	network pharmacist for any service covered by the health 97
147	147	insurance policy which is within the scope of practice of a 98
148	148	pharmacist licensed under chapter 465. 99
149	149	(b) Reimbursement to an in -network pharmacist may not be 100
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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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162	162	denied for the provision of a service that is within the s cope 101
163	163	of practice of a pharmacist licensed under chapter 465 if the 102
164	164	service, when provided by an allopathic physician licensed under 103
165	165	chapter 458, an osteopathic physician licensed under chapter 104
166	166	459, a physician assistant licensed under chapter 458 or chapte r 105
167	167	459, or an advanced practice registered nurse licensed under 106
168	168	chapter 464, is covered by the health insurance policy. 107
169	169	(2)(a) Pharmacists licensed under chapter 465 may count 108
170	170	toward network adequacy standards for provider access to 109
171	171	services provided with in the scope of practice of pharmacists. 110
172	172	(b) The participation of pharmacies in the network's drug 111
173	173	benefits does not satisfy the requirement of paragraph (a). 112
174	174	Section 5. Section 627.65723, Florida Statutes, is created 113
175	175	to read: 114
176	176	627.65723 Pharmacist selection and reimbursement. — 115
177	177	(1)(a) An insured or covered individual may select an in -116
178	178	network pharmacist for any service covered by the health 117
179	179	insurance policy which is within the scope of practice of a 118
180	180	pharmacist licensed under chapter 465. 119
181	181	(b) Reimbursement to an in-network pharmacist may not be 120
182	182	denied for the provision of a service that is within the scope 121
183	183	of practice of a pharmacist licensed under chapter 465 if the 122
184	184	service, when provided by an allopathic physician licensed under 123
185	185	chapter 458, an osteopathic physician licensed under chapter 124
186	186	459, a physician assistant licensed under chapter 458 or chapter 125
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195	195	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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199	199	459, or an advanced practice registered nurse licensed under 126
200	200	chapter 464, is covered by the health insurance policy. 127
201	201	(2)(a) Pharmacists licensed u nder chapter 465 may count 128
202	202	toward network adequacy standards for provider access to 129
203	203	services provided within the scope of practice of pharmacists. 130
204	204	(b) The participation of pharmacies in the network's drug 131
205	205	benefits does not satisfy the requirement of para graph (a). 132
206	206	Section 6. Section 641.3143, Florida Statutes, is created 133
207	207	to read: 134
208	208	641.3143 Pharmacist selection and reimbursement. — 135
209	209	(1)(a) A subscriber or covered individual may select an 136
210	210	in-network pharmacist for any service covered by the health 137
211	211	maintenance contract which is within the scope of practice of a 138
212	212	pharmacist licensed under chapter 465. 139
213	213	(b) Reimbursement to an in -network pharmacist may not be 140
214	214	denied for the provision of a service that is within the scope 141
215	215	of practice of a pharmacist license d under chapter 465 if the 142
216	216	service, when provided by an allopathic physician licensed under 143
217	217	chapter 458, an osteopathic physician licensed under chapter 144
218	218	459, a physician assistant licensed under chapter 458 or chapter 145
219	219	459, or an advanced practice registere d nurse licensed under 146
220	220	chapter 464, is covered by the health maintenance contract. 147
221	221	(2)(a) Pharmacists licensed under chapter 465 may count 148
222	222	toward network adequacy standards for provider access to 149
223	223	services provided within the scope of practice of pharmaci sts. 150
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236	236	(b) The participation of pharmacies in the network's drug 151
237	237	benefits does not satisfy the requirement of paragraph (a). 152
238	238	Section 7. This act shall take effect January 1, 2026. 153