Bill Text: FL S0516 | 2010 | Regular Session | Introduced

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Bill Title: Prescription Drugs Insurance Coverage [CPSC]

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2010-04-30 - Died in Committee on Banking and Insurance [S0516 Detail]

Download: Florida-2010-S0516-Introduced.html

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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.