The proposed bill introduces new requirements for health insurers and health maintenance organizations (HMOs) in Florida regarding prescription drug coverage and cost-sharing disclosures. It 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 that a notice of medical necessity from the treating physician can maintain coverage at existing levels. Additionally, insurers are required to maintain records of formulary changes and submit annual reports to the Office of Insurance Regulation, detailing these changes and their impact on insured individuals.

Furthermore, the bill establishes that any amount paid by a policyholder or on their behalf for prescription drugs will count towards their total contribution to any cost-sharing requirement, with specific disclosures required in health maintenance contracts and member handbooks starting January 1, 2027. It also mandates that pharmacy benefit managers apply these payments towards the insured's cost-sharing obligations and maintain records of third-party payments for prescription drugs. The bill aims to enhance transparency and protect consumers from unexpected changes in their prescription drug coverage while ensuring accurate accounting of their financial contributions. The act is set to take effect on July 1, 2026, applying to contracts entered into or renewed after January 1, 2027.

Statutes affected:
S 1166 Filed: 627.6699, 641.31, 409.967, 641.185