FL H0555

Creates section 465.1862 of Florida Statutes to regulate pharmacy benefit managers' contracts with pharmacies and maximum allowable cost pricing practices.

Requires pharmacy benefit managers to update maximum allowable cost pricing information at least every 7 calendar days and establish a reasonable process for prompt notification to contracted pharmacies.

Mandates that drugs placed on maximum allowable cost pricing lists must have at least two or more nationally available, therapeutically equivalent generic versions with significant cost differences and be rated "A" or "AB" in the FDA's Orange Book.

Requires pharmacy benefit managers to disclose to plan sponsors whether they use different maximum allowable cost pricing lists for retail versus mail order drugs and whether billing prices to plan sponsors differ from reimbursement prices to contracted pharmacies.

Mandates every pharmacy benefit manager contract include an appeal process with a 30-day filing deadline, 14-day resolution requirement, contact information for appeals, and requirements that denied appeals include denial reasons and alternative drug codes, while upheld appeals receive retroactive price adjustments.

Effective date: July 1, 2015.