FL H0961

Summary of Florida HB 961 - Prescription Drug Cost Reduction Act

• Establishes fiduciary duty for pharmacy benefit managers (PBMs) to act in the best interests of covered individuals and payors, requiring all funds received to be held in trust and passed through to reduce prescription drug costs

• Prohibits PBMs from engaging in spread pricing (charging payors more than the amount paid to pharmacies), charging pharmacies claim adjudication fees, making referrals to PBM-affiliated pharmacies, and retroactively denying or reducing reimbursement for covered claims

• Requires PBMs to update maximum allowable cost pricing at least every 7 days, respond to pharmacy appeals within 7 days, and report quarterly to payors all income from rebates, discounts, fees, and other financial benefits received from any source

• Mandates that group health plans, health insurers, and PBMs base patient coinsurance obligations on the net price of drugs (after rebates and discounts) rather than the list price

• Imposes $10,000 civil fine per violation for PBMs that violate these requirements, with potential registration revocation and subjection to the Florida Deceptive and Unfair Trade Practices Act for repeated violations; effective date January 1, 2021