FL S1342

Requires individual and group health insurers and HMOs to notify current and prospective insureds at least 60 days before any mid-year prescription drug formulary change, including posting on their website and sending direct notice electronically and by first-class mail to affected insureds and their treating physicians

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 at the existing level through the end of the policy year and may not increase costs, move the drug to a more restrictive tier, or impose new prior authorization or step-therapy requirements

Requires insurers and pharmacy benefit managers to apply any amount paid for a prescription drug by or on behalf of an insured—including manufacturer copay cards, product vouchers, and other financial assistance—toward the insured's deductible, copayment, coinsurance, and out-of-pocket maximum when the drug has no generic equivalent or has been authorized through prior authorization, step therapy, or an appeals process

Mandates that insurers submit annual reports to the Office of Insurance Regulation by March 1 detailing all formulary changes, the number of insureds impacted, increased costs to insureds, and any third-party payments not applied to out-of-pocket obligations; the office must compile and publish a summary report by May 1 each year

Applies to health insurance policies, health benefit plans, and health maintenance contracts entered into or renewed on or after January 1, 2026, with the Financial Services Commission required to adopt a medical necessity certification form by rule by that same date