Bill Text: FL H0275 | 2010 | Regular Session | Introduced

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Bill Title: Insurance Coverage for Prescription Drugs

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2010-04-30 - Died in Committee on Health Care Regulation Policy (HFPC) [H0275 Detail]

Download: Florida-2010-H0275-Introduced.html

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HB 275

1	A bill to be entitled
2	An act relating to insurance coverage for prescription
3	drugs; amending ss. 627.6045, 627.6561, and 641.31071,
4	F.S.; prohibiting health insurance policies or contracts
5	for a health care service plan from limiting, reducing, or
6	denying coverage for a prescription drug under certain
7	circumstances; providing that the insurer is not
8	prohibited from making uniform changes in its benefit
9	design or increasing cost-sharing obligations for a
10	prescription drug due to an increase in price; providing
11	that a change to any health insurance policy or contract
12	for a health care service plan is effective upon the
13	renewal of the policy or contract; requiring the insurer
14	to communicate the change and its effective date to the
15	insured; providing for nonapplicability to a managed care
16	plan under the Medicaid program; providing an effective
17	date.
18
19	Be It Enacted by the Legislature of the State of Florida:
20
21	Section 1. Subsections (5) and (6) are added to section
22	627.6045, Florida Statutes, to read:
23	627.6045 Preexisting condition.--A health insurance policy
24	must comply with the following:
25	(5) A health insurance policy or a contract for a health
26	care service plan that covers prescription drugs may not limit,
27	reduce, or deny coverage for a prescription drug to a particular
28	insured individual for the remainder of the current plan year
29	if, prior to the limitation, reduction, or denial of coverage:
30	(a) The insured was using the drug;
31	(b) The insured was covered under the policy or contract;
32	and
33	(c) The drug was covered under the policy or contract.
34	(6) A limitation, reduction, or denial of coverage
35	includes removing a drug from the formulary or other drug list,
36	imposing new management tools regarding prior authorization or
37	the use of the drug, placing the drug on a formulary tier that
38	increases the patient's cost-sharing obligations, or otherwise
39	increasing the patient's cost-sharing obligations for obtaining
40	the drug. This subsection does not prohibit an insurer from
41	making uniform changes in its benefit design which apply to all
42	covered drugs or from increasing cost-sharing obligations for a
43	drug due to a percentage coinsurance payment that increases in
44	proportion to an increase in the price of the drug. Any change
45	to a health insurance policy or a contract for a health care
46	service plan that covers prescription drugs is effective upon
47	the renewal of the policy or contract. The insurer shall
48	communicate this change and its effective date to the insured
49	during the open enrollment period. This section does not apply
50	to a managed care plan under the Medicaid program.
51	Section 2. Subsections (16) and (17) are added to section
52	627.6561, Florida Statutes, to read:
53	627.6561 Preexisting conditions.--
54	(16) A health insurance policy or a contract for a health
55	care service plan that covers prescription drugs may not limit,
56	reduce, or deny coverage for a prescription drug to a particular
57	insured individual for the remainder of the current plan year
58	if, prior to the limitation, reduction, or denial of coverage:
59	(a) The insured was using the drug;
60	(b) The insured was covered under the policy or contract;
61	and
62	(c) The drug was covered under the policy or contract.
63	(17) A limitation, reduction, or denial of coverage
64	includes removing a drug from the formulary or other drug list,
65	imposing new management tools regarding prior authorization or
66	the use of the drug, placing the drug on a formulary tier that
67	increases the patient's cost-sharing obligations, or otherwise
68	increasing the patient's cost-sharing obligations for obtaining
69	the drug. This subsection does not prohibit an insurer from
70	making uniform changes in its benefit design which apply to all
71	covered drugs or from increasing cost-sharing obligations for a
72	drug due to a percentage coinsurance payment that increases in
73	proportion to an increase in the price of the drug. Any change
74	to a health insurance policy or a contract for a health care
75	service plan that covers prescription drugs is effective upon
76	the renewal of the policy or contract. The insurer shall
77	communicate this change and its effective date to the insured
78	during the open enrollment period. This section does not apply
79	to a managed care plan under the Medicaid program.
80	Section 3. Subsections (14) and (15) are added to section
81	641.31071, Florida Statutes, to read:
82	641.31071 Preexisting conditions.--
83	(14) A health insurance policy or a contract for a health
84	care service plan that covers prescription drugs may not limit,
85	reduce, or deny coverage for a prescription drug to a particular
86	insured individual for the remainder of the current plan year
87	if, prior to the limitation, reduction, or denial of coverage:
88	(a) The insured was using the drug;
89	(b) The insured was covered under the policy or contract;
90	and
91	(c) The drug was covered under the policy or contract.
92	(15) A limitation, reduction, or denial of coverage
93	includes removing a drug from the formulary or other drug list,
94	imposing new management tools regarding prior authorization or
95	the use of the drug, placing the drug on a formulary tier that
96	increases the patient's cost-sharing obligations, or otherwise
97	increasing the patient's cost-sharing obligations for obtaining
98	the drug. This subsection does not prohibit an insurer from
99	making uniform changes in its benefit design which apply to all
100	covered drugs or from increasing cost-sharing obligations for a
101	drug due to a percentage coinsurance payment that increases in
102	proportion to an increase in the price of the drug. Any change
103	to a health insurance policy or a contract for a health care
104	service plan that covers prescription drugs is effective upon
105	the renewal of the policy or contract. The insurer shall
106	communicate this change and its effective date to the insured
107	during the open enrollment period. This section does not apply
108	to a managed care plan under the Medicaid program.
109	Section 4. This act shall take effect July 1, 2010.

CODING: Words stricken are deletions; words underlined are additions.