FL H0583

Health insurers and health maintenance organizations must allow insureds/subscribers with HIV diagnoses to access pharmaceutical services at both network and credentialed out-of-network retail pharmacies.

Out-of-network retail pharmacies may be credentialed using the same procedures and criteria as network pharmacy selection, with insurers/HMOs authorized to charge a credentialing fee not exceeding $1,500.

Insureds/subscribers cannot be charged higher cost-sharing amounts at credentialed out-of-network pharmacies than at network retail pharmacies, and all cost-sharing counts toward annual plan limits.

Out-of-network retail pharmacies credentialed under this act receive reimbursement at the same rate as mail order pharmacies under contract with the insurer/HMO.

The law applies to plans issued, delivered, or renewed in small group, individual, and large group markets, effective July 1, 2016.