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FL H1543
Bill
Status
Failed
3/8/2024
Primary Sponsor
Karen Gonzalez Pittman
Click for details
AI Summary
- Health insurers and HMOs must notify current and prospective insureds of any prescription drug formulary changes at least 60 days before the effective date, both on their website and by electronic and first-class mail to affected individuals and their treating physicians
- If a treating physician submits a one-page medical necessity certification to the insurer at least 30 days before the formulary change takes effect, the insurer must continue coverage of the prescribed drug at the existing level through the end of the policy 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, drugs moved to higher-cost tiers, number of insureds notified, and increased dollar costs to insureds; the Office must compile and publish a summary report by May 1 and submit it to the Governor and Legislature
- The Financial Services Commission must adopt a standardized medical necessity notice form by rule by January 1, 2025; the act applies to policies entered into or renewed on or after January 1, 2025, and excludes grandfathered health plans and Medicaid managed care plans
Legislative Description
Prescription Drug Coverage
Last Action
Died in Select Committee on Health Innovation
3/8/2024
Committee Referrals
Select Committee on Health Innovation1/13/2024
Full Bill Text
No bill text available