House Bill 899 establishes new requirements for health insurers and health maintenance organizations (HMOs) in Florida regarding prescription drug coverage disclosures and consumer protections. The bill mandates that insurers notify current and prospective insureds, as well as their treating physicians, of any changes to prescription drug formularies at least 60 days prior to the effective date. This notification must include details about the affected drugs and inform insureds that they can maintain coverage at existing levels by submitting a notice of medical necessity from their physician. Additionally, the bill requires insurers to keep records of formulary changes and submit annual reports to the Office of Insurance Regulation, detailing these changes and their impact on insureds.

Furthermore, the bill introduces provisions that require HMOs to authorize coverage for prescribed drugs deemed medically necessary by the treating physician until the end of the contract year, prohibiting any modifications to coverage during that period. It also mandates that any amounts paid by subscribers or on their behalf must be applied toward their total contribution to cost-sharing requirements, effective for contracts issued or renewed on or after January 1, 2026. The act aims to enhance transparency, protect consumers from unexpected changes in their prescription drug coverage, and ensure access to necessary medications, with an effective date of July 1, 2025.

Statutes affected:
H 899 Filed: 627.6699, 641.31, 409.967, 641.185