FL S0746

Insurers and HMOs must notify current and prospective enrollees and their treating physicians at least 60 days before any mid-year prescription drug formulary change, with notification posted on the insurer's website and sent by electronic and first-class mail

If a treating physician submits a one-page medical necessity certification to the insurer at least 30 days before a formulary change takes effect, the insurer must continue coverage of the prescribed drug at the existing level through the end of the policy or contract year

Insurers receiving a medical necessity notice are prohibited from increasing out-of-pocket costs, moving the drug to a more restrictive tier, denying previously approved coverage, or imposing new prior authorization or step-therapy requirements for the remainder of the policy year

Insurers and HMOs must submit annual reports to the Office of Insurance Regulation by March 1 detailing all formulary changes, including drugs removed, tier changes, number of enrollees notified, and increased costs to enrollees; the office must compile and publicly publish a summary report by May 1

The act applies to policies, health benefit plans, and HMO contracts entered into or renewed on or after January 1, 2024, and requires the Financial Services Commission to adopt a standardized medical necessity certification form by that date