House Bill 899 introduces significant changes to prescription drug coverage requirements for health insurers and health maintenance organizations (HMOs) in Florida. 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 detail the affected drugs and inform that a notice of medical necessity from the treating physician can maintain coverage at existing levels. Additionally, the bill requires insurers to maintain records of formulary changes and submit annual reports to the Office of Insurance Regulation. It also establishes that any payments made for prescription drugs must count towards the insured's total cost-sharing obligations, particularly for drugs without a generic equivalent or those requiring prior authorization.

Furthermore, the bill enhances protections for subscribers of HMOs by requiring them to authorize coverage for medically necessary prescribed drugs until the end of the contract year, prohibiting any modifications during that period, including increases in out-of-pocket costs or changes in coverage tiers. HMOs must also maintain records of formulary changes and report annually on these changes, including any drugs removed from the formulary. The provisions of the bill will apply to health insurance policies and contracts entered into or renewed on or after January 1, 2026, with an effective date of July 1, 2025. Overall, HB 899 aims to improve transparency and consumer protections in Florida's health insurance landscape regarding prescription drug coverage.

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