FL S1166

Requires health insurers and HMOs to notify current and prospective insureds at least 60 days before any mid-year prescription drug formulary changes, including direct notification to affected patients and their treating physicians by mail and electronically

Mandates that insurers continue coverage of a prescription drug through the end of the policy year if the treating physician submits a one-page medical necessity certification at least 30 days before a formulary change takes effect, prohibiting increased costs, tier changes, or new prior authorization requirements

Requires insurers and pharmacy benefit managers to apply all payments made by or on behalf of insureds—including manufacturer copay cards, vouchers, and third-party assistance—toward deductibles and out-of-pocket maximums for drugs without generic equivalents or for authorized brand-name drugs

Obligates health insurers and HMOs to submit annual reports to the Office of Insurance Regulation by March 1 detailing formulary changes, number of impacted insureds, and increased costs, with the office compiling a public 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, 2027, with the Financial Services Commission required to adopt a medical necessity form by that date