The bill amends Florida Statutes concerning Medicaid pharmacy services by eliminating the requirement for Medicaid managed care plans to cover prescription drug services, as indicated by the deletion of relevant language in section 409.973. Starting July 1, 2025, the Agency for Health Care Administration will directly reimburse Medicaid providers for pharmacy services through a fee-for-service system, irrespective of the recipient's prior enrollment in a managed care plan. The agency will also establish reimbursement rates, dispensing fees, and supplemental rebates, as outlined in the new insertions in section 409.908. Additionally, the agency is tasked with managing pharmacy services for all Medicaid recipients, implementing a Medicaid prescribed-drug spending-control program, and adopting necessary rules to facilitate these changes.

The bill further outlines provisions for nursing home and healthcare service reimbursements, including a maximum square footage for nursing home beds and a ventilator supplemental payment. It introduces reimbursement methodologies for various healthcare services, allowing for supplemental payments for providers serving a higher percentage of Medicaid patients. The bill also specifies changes to the reimbursement process for transportation services, emphasizing cost-effective purchasing strategies. Moreover, it proposes a Medicaid behavioral drug management system and a prescription drug management system to enhance 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 drugs dispensed to institutional recipients. The overall intent is to streamline Medicaid services while ensuring access to necessary medications and controlling costs, with the bill set to take effect on July 1, 2025.

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