FL H0765

Creates Section 465.1862, Florida Statutes, establishing regulatory requirements for pharmacy benefit managers (PBMs) contracting with Florida pharmacies.

Requires PBM-pharmacy contracts to be executed annually by January 1, include MAC pricing methodology and sources, update pricing at least every 7 calendar days, and maintain procedures to eliminate or modify MAC prices consistent with marketplace changes.

Restricts MAC list inclusion to drugs with at least three nationally available, therapeutically equivalent generic alternatives with significant cost differences and requires products be FDA-rated as therapeutically equivalent or "A" rated.

Mandates PBMs disclose to plan sponsors the MAC pricing methodology, whether MAC lists differ between retail and mail order drugs, and whether identical MAC lists are used for billing sponsors versus reimbursing network pharmacies.

Requires PBM-pharmacy contracts include an appeal process for MAC pricing disputes with 90-day appeal windows, 7-day resolution timelines, dedicated contact numbers, and retroactive adjustments for upheld appeals applied to all similarly situated network pharmacies statewide.

Requires PBMs to contractually commit to aggregate average reimbursement rates for generic drugs calculated using actual pharmacy payments and including all generics dispensed regardless of MAC pricing status, effective July 1, 2014.