November 18, 2019
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       Florida Senate - 2010                                     SB 516
       
       
       
       By Senator Fasano
       
       
       
       
       11-00311-10                                            2010516__
    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
    5         contracts for a health care service plan from
    6         limiting, reducing, or denying coverage for a
    7         prescription drug under certain circumstances;
    8         providing that the insurer is not prohibited from
    9         making uniform changes in its benefit design or
   10         increasing cost-sharing obligations for a prescription
   11         drug due to an increase in price; providing that a
   12         change to any health insurance policy or contract for
   13         a health care service plan is effective upon the
   14         renewal of the policy or contract; requiring the
   15         insurer to communicate the change and its effective
   16         date to the insured; providing for nonapplicability to
   17         a managed care plan under the Medicaid program;
   18         providing an effective date.
   19  
   20  Be It Enacted by the Legislature of the State of Florida:
   21  
   22         Section 1. Subsections (5) and (6) are added to section
   23  627.6045, Florida Statutes, to read:
   24         627.6045 Preexisting condition.—A health insurance policy
   25  must comply with the following:
   26         (5) A health insurance policy or a contract for a health
   27  care service plan that covers prescription drugs may not limit,
   28  reduce, or deny coverage for a prescription drug to a particular
   29  insured individual for the remainder of the current plan year
   30  if, prior to the limitation, reduction, or denial of coverage:
   31         (a) The insured was using the drug;
   32         (b) The insured was covered under the policy or contract;
   33  and
   34         (c) The drug was covered under the policy or contract.
   35         (6) A limitation, reduction, or denial of coverage includes
   36  removing a drug from the formulary or other drug list, imposing
   37  new management tools regarding prior authorization or the use of
   38  the drug, placing the drug on a formulary tier that increases
   39  the patient’s cost-sharing obligations, or otherwise increasing
   40  the patient’s cost-sharing obligations for obtaining the drug.
   41  This subsection does not prohibit an insurer from making uniform
   42  changes in its benefit design which apply to all covered drugs
   43  or from increasing cost-sharing obligations for a drug due to a
   44  percentage coinsurance payment that increases in proportion to
   45  an increase in the price of the drug. Any change to a health
   46  insurance policy or a contract for a health care service plan
   47  that covers prescription drugs is effective upon the renewal of
   48  the policy or contract. The insurer shall communicate this
   49  change and its effective date to the insured during the open
   50  enrollment period. This section does not apply to a managed care
   51  plan under the Medicaid program.
   52         Section 2. Subsections (16) and (17) are added to section
   53  627.6561, Florida Statutes, to read:
   54         627.6561 Preexisting conditions.—
   55         (16) A health insurance policy or a contract for a health
   56  care service plan that covers prescription drugs may not limit,
   57  reduce, or deny coverage for a prescription drug to a particular
   58  insured individual for the remainder of the current plan year
   59  if, prior to the limitation, reduction, or denial of coverage:
   60         (a)The insured was using the drug;
   61         (b)The insured was covered under the policy or contract;
   62  and
   63         (c)The drug was covered under the policy or contract.
   64         (17) A limitation, reduction, or denial of coverage
   65  includes removing a drug from the formulary or other drug list,
   66  imposing new management tools regarding prior authorization or
   67  the use of the drug, placing the drug on a formulary tier that
   68  increases the patient’s cost-sharing obligations, or otherwise
   69  increasing the patient’s cost-sharing obligations for obtaining
   70  the drug. This subsection does not prohibit an insurer from
   71  making uniform changes in its benefit design which apply to all
   72  covered drugs or from increasing cost-sharing obligations for a
   73  drug due to a percentage coinsurance payment that increases in
   74  proportion to an increase in the price of the drug. Any change
   75  to a health insurance policy or a contract for a health care
   76  service plan that covers prescription drugs is effective upon
   77  the renewal of the policy or contract. The insurer shall
   78  communicate this change and its effective date to the insured
   79  during the open enrollment period. This section does not apply
   80  to a managed care plan under the Medicaid program.
   81         Section 3. Subsections (14) and (15) are added to section
   82  641.31071, Florida Statutes, to read:
   83         641.31071 Preexisting conditions.—
   84         (14) A health insurance policy or a contract for a health
   85  care service plan that covers prescription drugs may not limit,
   86  reduce, or deny coverage for a prescription drug to a particular
   87  insured individual for the remainder of the current plan year
   88  if, prior to the limitation, reduction, or denial of coverage:
   89         (a) The insured was using the drug;
   90         (b) The insured was covered under the policy or contract;
   91  and
   92         (c) The drug was covered under the policy or contract.
   93         (15) A limitation, reduction, or denial of coverage
   94  includes removing a drug from the formulary or other drug list,
   95  imposing new management tools regarding prior authorization or
   96  the use of the drug, placing the drug on a formulary tier that
   97  increases the patient’s cost-sharing obligations, or otherwise
   98  increasing the patient’s cost-sharing obligations for obtaining
   99  the drug. This subsection does not prohibit an insurer from
  100  making uniform changes in its benefit design which apply to all
  101  covered drugs or from increasing cost-sharing obligations for a
  102  drug due to a percentage coinsurance payment that increases in
  103  proportion to an increase in the price of the drug. Any change
  104  to a health insurance policy or a contract for a health care
  105  service plan that covers prescription drugs is effective upon
  106  the renewal of the policy or contract. The insurer shall
  107  communicate this change and its effective date to the insured
  108  during the open enrollment period. This section does not apply
  109  to a managed care plan under the Medicaid program.
  110         Section 4. This act shall take effect July 1, 2010.

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