Bill Summary – FastDemocracy

       Florida Senate - 2024                                     SB 228
       
       
        
       By Senator Wright
       
       
       
       
       
       8-00104-24                                             2024228__
                      A bill to be entitled                      
       An act relating to health insurance cost sharing;
       creating s. 627.6383, F.S.; defining the term “cost
       sharing requirement”; requiring specified individual
       health insurers and their pharmacy benefit managers to
       apply payments by or on behalf of insureds toward the
       total contributions of the insureds’ cost-sharing
       requirements; providing construction; providing
       applicability; amending s. 627.6385, F.S.; providing
       disclosure requirements for specified health insurers
       and their pharmacy benefit managers; providing
       applicability; amending s. 627.64741, F.S.; requiring
       that specified contracts require pharmacy benefit
       managers to apply payments by or on behalf of insureds
       toward the insureds’ total contributions to cost
       sharing requirements; providing applicability;
       providing disclosure requirements for such pharmacy
       benefit managers; creating s. 627.65715, F.S.;
       defining the term “cost-sharing requirement”;
       requiring specified group health insurers and their
       pharmacy benefit managers to apply payments by or on
       behalf of insureds toward the total contributions of
       the insureds’ cost-sharing requirements; providing
       construction; providing disclosure requirements for
       specified group health insurers and their pharmacy
       benefit managers; providing applicability; amending s.
       627.6572, F.S.; requiring that specified contracts
       require pharmacy benefit managers to apply payments by
       or on behalf of insureds toward the insureds’ total
       contributions to cost-sharing requirements; providing
       applicability; providing disclosure requirements for
       such pharmacy benefit managers; amending s. 627.6699,
       F.S.; requiring small employer carriers to comply with
       certain cost-sharing requirements; making technical
       changes; amending s. 641.31, F.S.; defining the term
       “cost-sharing requirement”; requiring specified health
       maintenance organizations and their pharmacy benefit
       managers to apply payments by or on behalf of
       subscribers toward the total contributions of the
       subscribers’ cost-sharing requirements; providing
       construction; providing disclosure requirements for
       such health maintenance organizations and pharmacy
       benefit managers; providing applicability; amending s.
       641.314, F.S.; requiring specified contracts to
       require pharmacy benefit managers to apply payments by
       or on behalf of subscribers toward the subscribers’
       total contributions to cost-sharing requirements;
       providing applicability; providing disclosure
       requirements for such pharmacy benefit managers;
       amending s. 409.967, F.S.; conforming a cross
       reference; amending s. 641.185, F.S.; conforming a
       provision to changes made by the act; providing a
       declaration of important state interest; providing an
       effective date.
        
Be It Enacted by the Legislature of the State of Florida:

       Section 1. Section 627.6383, Florida Statutes, is created
to read:
       627.6383 Cost-sharing requirements.—
       (1) As used in this section, the term “cost-sharing
requirement” means a dollar limit, a deductible, a copayment,
coinsurance, or any other out-of-pocket expense imposed on an
insured, including, but not limited to, the annual limitation on
cost sharing subject to 42 U.S.C. s. 18022.
       (2)(a) Each health insurer issuing, delivering, or renewing
a policy that provides prescription drug coverage in this state,
or each pharmacy benefit manager on behalf of such health
insurer, shall apply any amount paid by an insured or by another
person on behalf of the insured toward the insured’s total
contribution to any cost-sharing requirement.
       (b) The amount paid by or on behalf of the insured which is
applied toward the insured’s total contribution to any cost
sharing requirement under paragraph (a) includes, but is not
limited to, any payment with or any discount through financial
assistance, a manufacturer copay card, a product voucher, or any
other reduction in out-of-pocket expenses made by or on behalf
of the insured for a prescription drug.
       (3) This section applies to any health insurance policy
issued, delivered, or renewed in this state on or after January
1, 2025.
       Section 2. Present subsections (2) and (3) of section
627.6385, Florida Statutes, are redesignated as subsections (3)
and (4), respectively, a new subsection (2) is added to that
section, and present subsection (2) of that section is amended,
to read:
       627.6385 Disclosures to policyholders; calculations of cost
sharing.—
       (2) Each health insurer issuing, delivering, or renewing a
policy that provides prescription drug coverage in this state,
regardless of whether the prescription drug benefits are
administered or managed by the health insurer or by a pharmacy
benefit manager on behalf of the health insurer, shall disclose
on its website that any amount paid by a policyholder or by
another person on behalf of the policyholder must be applied
toward the policyholder’s total contribution to any cost-sharing
requirement pursuant to s. 627.6383. This subsection applies to
any policy issued, delivered, or renewed in this state on or
after January 1, 2025.
       (3)(2) Each health insurer shall include in every policy
delivered or issued for delivery to any person in this the state
or in materials provided as required by s. 627.64725 a notice
that the information required by this section is available
electronically and the website address of the website where the
information can be accessed. In addition, each health insurer
issuing, delivering, or renewing a policy that provides
prescription drug coverage in this state, regardless of whether
the prescription drug benefits are administered or managed by
the health insurer or by a pharmacy benefit manager on behalf of
the health insurer, shall include in every policy issued,
delivered, or renewed to any person in this state on or after
January 1, 2025, the disclosure that any amount paid by a
policyholder or by another person on behalf of the policyholder
must be applied toward the policyholder’s total contribution to
any cost-sharing requirement pursuant to s. 627.6383.
       Section 3. Paragraph (c) is added to subsection (2) of
section 627.64741, Florida Statutes, to read:
       627.64741 Pharmacy benefit manager contracts.—
       (2) In addition to the requirements of part VII of chapter
626, a contract between a health insurer and a pharmacy benefit
manager must require that the pharmacy benefit manager:
       (c)1. Apply any amount paid by an insured or by another
person on behalf of the insured toward the insured’s total
contribution to any cost-sharing requirement pursuant to s.
627.6383. This subparagraph applies to any insured whose
insurance policy is issued, delivered, or renewed in this state
on or after January 1, 2025.
       2. Disclose to every insured whose insurance policy is
issued, delivered, or renewed in this state on or after January
1, 2025, that the pharmacy benefit manager shall apply any
amount paid by the insured or by another person on behalf of the
insured toward the insured’s total contribution to any cost
sharing requirement pursuant to s. 627.6383.
       Section 4. Section 627.65715, Florida Statutes, is created
to read:
       627.65715 Cost-sharing requirements.—
       (1) As used in this section, the term “cost-sharing
requirement” means a dollar limit, a deductible, a copayment,
coinsurance, or any other out-of-pocket expense imposed on an
insured, including, but not limited to, the annual limitation on
cost sharing subject to 42 U.S.C. s. 18022.
       (2)(a) Each insurer issuing, delivering, or renewing a
policy that provides prescription drug coverage in this state,
or each pharmacy benefit manager on behalf of such insurer,
shall apply any amount paid by an insured or by another person
on behalf of the insured toward the insured’s total contribution
to any cost-sharing requirement.
       (b) The amount paid by or on behalf of the insured which is
applied toward the insured’s total contribution to any cost
sharing requirement under paragraph (a) includes, but is not
limited to, any payment with or any discount through financial
assistance, a manufacturer copay card, a product voucher, or any
other reduction in out-of-pocket expenses made by or on behalf
of the insured for a prescription drug.
       (3) Each insurer issuing, delivering, or renewing a policy
that provides prescription drug coverage in this state,
regardless of whether the prescription drug benefits are
administered or managed by the insurer or by a pharmacy benefit
manager on behalf of the insurer, shall disclose on its website
and in every policy issued, delivered, or renewed in this state
on or after January 1, 2025, that any amount paid by an insured
or by another person on behalf of the insured must be applied
toward the insured’s total contribution to any cost-sharing
requirement.
       (4) This section applies to any group health insurance
policy issued, delivered, or renewed in this state on or after
January 1, 2025.
       Section 5. Paragraph (c) is added to subsection (2) of
section 627.6572, Florida Statutes, to read:
       627.6572 Pharmacy benefit manager contracts.—
       (2) In addition to the requirements of part VII of chapter
626, a contract between a health insurer and a pharmacy benefit
manager must require that the pharmacy benefit manager:
       (c)1. Apply any amount paid by an insured or by another
person on behalf of the insured toward the insured’s total
contribution to any cost-sharing requirement pursuant to s.
627.65715. This subparagraph applies to any insured whose
insurance policy is issued, delivered, or renewed in this state
on or after January 1, 2025.
       2. Disclose to every insured whose insurance policy is
issued, delivered, or renewed in this state on or after January
1, 2025, that the pharmacy benefit manager shall apply any
amount paid by the insured or by another person on behalf of the
insured toward the insured’s total contribution to any cost
sharing requirement pursuant to s. 627.65715.
       Section 6. Paragraph (e) of subsection (5) of section
627.6699, Florida Statutes, is amended to read:
       627.6699 Employee Health Care Access Act.—
       (5) AVAILABILITY OF COVERAGE.—
       (e) All health benefit plans issued under this section must
comply with the following conditions:
       1. For employers who have fewer than two employees, a late
enrollee may be excluded from coverage for no longer than 24
months if he or she was not covered by creditable coverage
continually to a date not more than 63 days before the effective
date of his or her new coverage.
       2. Any requirement used by a small employer carrier in
determining whether to provide coverage to a small employer
group, including requirements for minimum participation of
eligible employees and minimum employer contributions, must be
applied uniformly among all small employer groups having the
same number of eligible employees applying for coverage or
receiving coverage from the small employer carrier, except that
a small employer carrier that participates in, administers, or
issues health benefits pursuant to s. 381.0406 which do not
include a preexisting condition exclusion may require as a
condition of offering such benefits that the employer has had no
health insurance coverage for its employees for a period of at
least 6 months. A small employer carrier may vary application of
minimum participation requirements and minimum employer
contribution requirements only by the size of the small employer
group.
       3. In applying minimum participation requirements with
respect to a small employer, a small employer carrier may shall
not consider as an eligible employee employees or dependents who
have qualifying existing coverage in an employer-based group
insurance plan or an ERISA qualified self-insurance plan in
determining whether the applicable percentage of participation
is met. However, a small employer carrier may count eligible
employees and dependents who have coverage under another health
plan that is sponsored by that employer.
       4. A small employer carrier may shall not increase any
requirement for minimum employee participation or any
requirement for minimum employer contribution applicable to a
small employer at any time after the small employer has been
accepted for coverage, unless the employer size has changed, in
which case the small employer carrier may apply the requirements
that are applicable to the new group size.
       5. If a small employer carrier offers coverage to a small
employer, it must offer coverage to all the small employer’s
eligible employees and their dependents. A small employer
carrier may not offer coverage limited to certain persons in a
group or to part of a group, except with respect to late
enrollees.
       6. A small employer carrier may not modify any health
benefit plan issued to a small employer with respect to a small
employer or any eligible employee or dependent through riders,
endorsements, or otherwise to restrict or exclude coverage for
certain diseases or medical conditions otherwise covered by the
health benefit plan.
       7. An initial enrollment period of at least 30 days must be
provided. An annual 30-day open enrollment period must be
offered to each small employer’s eligible employees and their
dependents. A small employer carrier must provide special
enrollment periods as required by s. 627.65615.
       8. A small employer carrier shall comply with s. 627.65715
with respect to contribution to cost-sharing requirements, as
defined in that section.
       Section 7. Subsection (48) is added to section 641.31,
Florida Statutes, to read:
       641.31 Health maintenance contracts.—
       (48)(a) As used in this subsection, the term “cost-sharing
requirement” means a dollar limit, a deductible, a copayment,
coinsurance, or any other out-of-pocket expense imposed on a
subscriber, including, but not limited to, the annual limitation
on cost sharing subject to 42 U.S.C. s. 18022.
       (b)1. Each health maintenance organization issuing,
delivering, or renewing a health maintenance contract or
certificate that provides prescription drug coverage in this
state, or each pharmacy benefit manager on behalf of such health
maintenance organization, shall apply any amount paid by a
subscriber or by another person on behalf of the subscriber
toward the subscriber’s total contribution to any cost-sharing
requirement.
       2. The amount paid by or on behalf of the subscriber which
is applied toward the subscriber’s total contribution to any
cost-sharing requirement under subparagraph 1. includes, but is
not limited to, any payment with or any discount through
financial assistance, a manufacturer copay card, a product
voucher, or any other reduction in out-of-pocket expenses made
by or on behalf of the subscriber for a prescription drug.
       (c) Each health maintenance organization issuing,
delivering, or renewing a health maintenance contract or
certificate that provides prescription drug coverage in this
state, regardless of whether the prescription drug benefits are
administered or managed by the health maintenance organization
or by a pharmacy benefit manager on behalf of the health
maintenance organization, shall disclose on its website and in
every subscriber’s health maintenance contract, certificate, or
member handbook issued, delivered, or renewed in this state on
or after January 1, 2025, that any amount paid by a subscriber
or by another person on behalf of the subscriber must be applied
toward the subscriber’s total