Bill Text: FL S0534 | 2018 | Regular Session | Introduced
Bill Title: Regulation of Pharmacy Benefits Managers
Spectrum: Partisan Bill (Republican 2-0)
Status: (Failed) 2018-03-10 - Died in Health Policy [S0534 Detail]
Download: Florida-2018-S0534-Introduced.html
Florida Senate - 2018 SB 534 By Senator Grimsley 26-00674-18 2018534__ 1 A bill to be entitled 2 An act relating to the regulation of pharmacy benefits 3 managers; amending s. 465.1862, F.S.; deleting an 4 obsolete cross-reference; defining the term “health 5 insurance plan”; amending s. 626.88, F.S.; redefining 6 the term “administrator” to include pharmacy benefits 7 managers; making technical changes; providing an 8 effective date. 9 10 Be It Enacted by the Legislature of the State of Florida: 11 12 Section 1. Paragraph (b) of subsection (1) of section 13 465.1862, Florida Statutes, is amended to read: 14 465.1862 Pharmacy benefits manager contracts.— 15 (1) As used in this section, the term: 16 (b) “Pharmacy benefits manager” means a person or entity 17 doing business in this state which contracts to administer or 18 manage prescription drug benefits on behalf of a health 19 insurance plan, as defined in former s. 627.6482,to residents 20 of this state. For purposes of this paragraph, the term “health 21 insurance plan” means any hospital and medical expense incurred 22 policy, minimum premium plan, stop-loss coverage, health 23 maintenance organization contract, prepaid health clinic 24 contract, multiple-employer welfare arrangement contract, or 25 fraternal benefit society health benefits contract, whether sold 26 as an individual or group policy or contract; but the term does 27 not include any policy covering medical payments coverage or 28 personal injury protection coverage in a motor vehicle policy, 29 coverage issued as a supplement to liability insurance, or 30 workers’ compensation. 31 Section 2. Subsection (1) of section 626.88, Florida 32 Statutes, is amended to read: 33 626.88 Definitions.—For the purposes of this part, the 34 term: 35 (1) “Administrator” meansisany person who directly or 36 indirectly solicits or effects coverage of, collects charges or 37 premiums from, or adjusts or settles claims on residents of this 38 state in connection with authorized commercial self-insurance 39 funds or with insured or self-insured programs which provide 40 life or health insurance coverage or coverage of any other 41 expenses described in s. 624.33(1);orany person who, through a 42 health care risk contract as defined in s. 641.234 with an 43 insurer or health maintenance organization, provides billing and 44 collection services to health insurers and health maintenance 45 organizations on behalf of health care providers; or a pharmacy 46 benefits manager as defined in s. 465.1862(1). The term does not 47 include, other thanany ofthe following persons: 48 (a) An employer or wholly owned direct or indirect 49 subsidiary of an employer, on behalf of such employer’s 50 employees or the employees of one or more subsidiary or 51 affiliated corporations of such employer. 52 (b) A union on behalf of its members. 53 (c) An insurance company which is either authorized to 54 transact insurance in this state or is acting as an insurer with 55 respect to a policy lawfully issued and delivered by such 56 company in and pursuant to the laws of a state in which the 57 insurer was authorized to transact an insurance business. 58 (d) A health care services plan, health maintenance 59 organization, professional service plan corporation, or person 60 in the business of providing continuing care, possessing a valid 61 certificate of authority issued by the office, and the sales 62 representatives thereof, if the activities of such entity are 63 limited to the activities permitted under the certificate of 64 authority. 65 (e) An entity that is affiliated with an insurer and that 66 only performs the contractual duties, between the administrator 67 and the insurer, of an administrator for the direct and assumed 68 insurance business of the affiliated insurer. The insurer is 69 responsible for the acts of the administrator and is responsible 70 for providing all of the administrator’s books and records to 71 the insurance commissioner, upon a request from the insurance 72 commissioner. For purposes of this paragraph, the term “insurer” 73 means a licensed insurance company, health maintenance 74 organization, prepaid limited health service organization, or 75 prepaid health clinic. 76 (f) A nonresident entity licensed in its state of domicile 77 as an administrator if its duties in this state are limited to 78 the administration of a group policy or plan of insurance and no 79 more than a total of 100 lives for all plans reside in this 80 state. 81 (g) An insurance agent licensed in this state whose 82 activities are limited exclusively to the sale of insurance. 83 (h) A person licensed as a managing general agent in this 84 state, whose activities are limited exclusively to the scope of 85 activities conveyed under such license. 86 (i) An adjuster licensed in this state whose activities are 87 limited to the adjustment of claims. 88 (j) A creditor on behalf of such creditor’s debtors with 89 respect to insurance covering a debt between the creditor and 90 its debtors. 91 (k) A trust and its trustees, agents, and employees acting 92 pursuant to such trust established in conformity with 29 U.S.C. 93 s. 186. 94 (l) A trust exempt from taxation under s. 501(a) of the 95 Internal Revenue Code, a trust satisfying the requirements of 96 ss. 624.438 and 624.439, or any governmental trust as defined in 97 s. 624.33(3), and the trustees and employees acting pursuant to 98 such trust, or a custodian and its agents and employees, 99 including individuals representing the trustees in overseeing 100 the activities of a service company or administrator, acting 101 pursuant to a custodial account which meets the requirements of 102 s. 401(f) of the Internal Revenue Code. 103 (m) A financial institution which is subject to supervision 104 or examination by federal or state authorities or a mortgage 105 lender licensed under chapter 494 who collects and remits 106 premiums to licensed insurance agents or authorized insurers 107 concurrently or in connection with mortgage loan payments. 108 (n) A credit card issuing company which advances for and 109 collects premiums or charges from its credit card holders who 110 have authorized such collection if such company does not adjust 111 or settle claims. 112 (o) A person who adjusts or settles claims in the normal 113 course of such person’s practice or employment as an attorney at 114 law and who does not collect charges or premiums in connection 115 with life or health insurance coverage. 116 (p) A person approved by the department who administers 117 only self-insured workers’ compensation plans. 118 (q) A service company or service agent and its employees, 119 authorized in accordance with ss. 626.895-626.899, serving only 120 a single employer plan, multiple-employer welfare arrangements, 121 or a combination thereof. 122 (r) Any provider or group practice, as defined in s. 123 456.053, providing services under the scope of the license of 124 the provider or the member of the group practice. 125 (s) Any hospital providing billing, claims, and collection 126 services solely on its own and its physicians’ behalf and 127 providing services under the scope of its license. 128 (t) A corporation not for profit whose membership consists 129 entirely of local governmental units authorized to enter into 130 risk management consortiums under s. 112.08. 131 132 A person who provides billing and collection services to health 133 insurers and health maintenance organizations on behalf of 134 health care providers shall comply withthe provisions ofss. 135 627.6131, 641.3155, and 641.51(4). 136 Section 3. This act shall take effect July 1, 2018.