Bill Text: FL S0860 | 2015 | Regular Session | Comm Sub

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Bill Title: Pharmacy

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Failed) 2015-05-01 - Died in Appropriations, companion bill(s) passed, see CS/CS/HB 1049 (Ch. 2015-127) [S0860 Detail]

Download: Florida-2015-S0860-Comm_Sub.html

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       Florida Senate - 2015                       CS for CS for SB 860
       
       
        
       By the Committees on Health Policy; and Banking and Insurance;
       and Senator Garcia
       
       
       
       
       588-03203-15                                           2015860c2
    1                        A bill to be entitled                      
    2         An act relating to pharmacy; creating s. 465.1862,
    3         F.S.; defining terms; requiring a pharmacy in a
    4         contract between a pharmacy benefit manager and the
    5         pharmacy to have the right to obtain from the manager
    6         a list of sources used to determine maximum allowable
    7         cost pricing; requiring a pharmacy benefit manager to
    8         periodically update maximum allowable cost pricing
    9         information and to provide a means for pharmacies to
   10         review such information within a specified time;
   11         requiring a pharmacy benefit manager to maintain a
   12         procedure to eliminate certain products from the list
   13         of products subject to maximum allowable cost pricing;
   14         specifying requirements for a pharmacy benefit manager
   15         to place a prescription drug on a list of products;
   16         requiring contracts between a pharmacy benefit manager
   17         and a pharmacy to include a specified process for
   18         appeal; requiring a pharmacy benefit manager to make
   19         adjustments to the maximum allowable cost price within
   20         a specified period if an appeal is upheld; providing
   21         an effective date.
   22          
   23  Be It Enacted by the Legislature of the State of Florida:
   24  
   25         Section 1.  Section 1. Section 465.1862, Florida Statutes,
   26  is created to read:
   27         465.1862 Pharmacy benefit managers.—
   28         (1) As used in this section, the term:
   29         (a) “Maximum allowable cost” means the upper limit or
   30  maximum amount that a health insurance plan will pay for generic
   31  prescription drugs or brand name prescription drugs that have
   32  available generic versions which are included on a list of
   33  products generated by the pharmacy benefit manager.
   34         (b) “Pharmacy benefit manager” means a person or entity
   35  doing business in this state which contracts to administer or
   36  manage prescription drug benefits on behalf of a health
   37  insurance plan that provides prescription drug benefits to
   38  residents of this state.
   39         (c) “Health insurance plan” has the same meaning as the
   40  term “health insurance” as defined in s. 627.6482(6).
   41         (2) In each contract between a pharmacy benefit manager and
   42  a pharmacy, the pharmacy shall have the right to obtain from the
   43  pharmacy benefit manager a current list of the sources used to
   44  determine the maximum allowable cost pricing. The pharmacy
   45  benefit manager must:
   46         (a) Update the maximum allowable cost pricing information
   47  at least every 7 business days and provide a means by which a
   48  contracted pharmacy may promptly review current pricing
   49  information in an electronic, print, or telephonic format that
   50  is readily available to a contracted pharmacy within 1 business
   51  day after the pricing information is updated at no cost to the
   52  contracted pharmacy.
   53         (b) Maintain a procedure to eliminate products from the
   54  list of products subject to maximum allowable cost pricing in a
   55  timely manner in order to remain consistent with changes in the
   56  marketplace.
   57         (3) To place a prescription drug on a list of products, a
   58  pharmacy benefit manager must ensure that the prescription drug
   59  is generally available for purchase by pharmacies in this state
   60  from a national or regional wholesaler and is not obsolete.
   61         (4)(a) Each contract between a pharmacy benefit manager and
   62  a pharmacy must include a process for appeal, investigation, and
   63  resolution of disputes regarding maximum allowable cost pricing.
   64  The process must:
   65         1. Limit the right to appeal to 30 calendar days after the
   66  initial claim.
   67         2. Require investigation and resolution by the pharmacy
   68  benefit manager of a dispute within 7 business days after an
   69  appeal is received by the pharmacy benefit manager.
   70         3. Include a telephone number at which a contracted
   71  pharmacy may contact the pharmacy benefit manager regarding an
   72  appeal.
   73         4. Require that the pharmacy benefit manager provide a
   74  reason for a denial of an appeal and identify the National Drug
   75  Code of a prescription drug that may be purchased by the
   76  contracted pharmacy at a price at or below the maximum allowable
   77  cost as determined by the pharmacy benefit manager.
   78         (b) If an appeal is upheld, the pharmacy benefit manager
   79  shall make an adjustment to the maximum allowable cost pricing
   80  within 1 business day after the date the appeal is upheld. The
   81  pharmacy benefit manager shall make the price adjustment
   82  applicable to all similarly situated contracted pharmacies.
   83         Section 2. This act shall take effect July 1, 2015.