The bill amends Florida Statutes concerning Medicaid pharmacy services by eliminating the requirement for Medicaid managed care plans to cover prescription drug services. Starting July 1, 2025, the Agency for Health Care Administration will directly reimburse Medicaid providers for pharmacy services through a fee-for-service system, independent of the recipient's prior enrollment in a managed care plan. The agency will also establish reimbursement rates, dispensing fees, and supplemental rebates, while managing pharmacy services for all Medicaid recipients. This change aims to streamline the reimbursement process and enhance access to necessary pharmacy services.

In addition to pharmacy services, the bill outlines provisions for nursing home care reimbursement, including a maximum square footage for beds, a minimum renovation cost, and supplemental payments for ventilator use. It allows for direct care supplemental payments to providers with high direct care hours and a significant percentage of Medicaid patients, while exempting certain facilities from the new pricing model. The bill also introduces a Medicaid behavioral drug management system and a prescription drug management system to improve care quality and prescribing practices. Key features include a step-therapy prior authorization process for non-preferred medications and a return and reuse program for dispensed drugs. The overall goal is to enhance the efficiency and effectiveness of Medicaid services while ensuring cost control and quality care, with an effective date of July 1, 2025.

Statutes affected:
S 1628 Filed: 409.973, 409.908, 409.912