HB 863 - Florida Patient Protection Act

• Requires managed care plans to establish medical exceptions processes allowing enrollees or providers to request coverage for clinically appropriate drugs not on formulary, with decisions made within 24-72 hours depending on medical urgency.

• Mandates managed care plans, health insurers, and health maintenance organizations provide broad therapeutic drug formularies with at least two products per class and publish formularies online with 24-hour update requirements.

• Prohibits health insurers and HMOs from using discriminatory benefit designs based on age, life expectancy, disability, diagnosis, or health condition; requires Office of Insurance Regulation to issue annual reports evaluating discriminatory practices.

• Establishes clear and convenient processes for prescribing providers to request overrides of step-therapy and fail-first protocols, with organizations required to grant overrides within 24 hours under specified clinical circumstances.

• Creates civil liability provisions allowing insureds to sue health insurers and HMO subscribers to sue health maintenance organizations for failure to provide covered services, with damages of at least $500 per violation or all actual damages, whichever is larger, plus attorney fees.