– Florida law prohibits employers from requiring mandatory mail-order prescriptions for their Florida employees.
– Employers must provide a sixty-day continuity of care period after midyear formulary changes.
– The law applies to PBM contracts with employer plans executed, amended, adjusted, or renewed on or after July 1, 2023.
– Employers must attest to the Florida Office of Insurance Regulation that their PBM agreements meet the new state standards.
– The law went into effect on January 1, 2024.
– State PBM licensing laws are becoming more common and are intended to benefit consumers by improving transparency and accountability in the PBM marketplace. 1. PBMs will be required to provide “pass through” pricing, where the amounts charged to the plan are the same as the amounts paid to the dispensing pharmacy, with no offset for reconciliation.
2. Direct or indirect “spread pricing” will be prohibited, which is when a PBM charges a plan a different amount for pharmacist services than it pays the pharmacy for those services.
3. PBMs must pass 100 percent of all manufacturer rebates to the plan, and any excess rebate proceeds must be used solely to offset copayments and deductibles for participants.
4. Participants cannot be required to receive medication by U.S. mail or third-party service unless the drug cannot be acquired at any retail pharmacy in the network.
5. PBMs are required to obtain licensure as third-party administrators and disclose all affiliated pharmacies and companies. They must also ensure that pharmacy networks meet or exceed Medicare’s network adequacy requirements and may not be composed solely of PBM-affiliated pharmacies.
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