No. SB 1158
Filed under Insurance.
Drug Prices and Coverage; Requiring the Agency for Health Care Administration to contract with an entity to designate reference price source countries and analyze certain data; requiring the agency to publish annually prescription drug reference prices; prohibiting pharmacies from charging cash-paying customers more than the reference prices for prescribed drugs and biological products; requiring prescription drug manufacturer permitholders to annually report to the agency international drug price data beginning on a specified date; requiring certain health insurers to limit covered prescription drug reimbursement to reference prices, etc.
Plain English Summary
AI-GENERATEDThe Agency for Health Care Administration must hire a contractor to pick benchmark countries and calculate a reference price for each prescription drug, updating the list annually and publishing it online each year.
Pharmacies may not charge cash-paying customers more than the reference price for a drug itself, though dispensing fees are unaffected; drug manufacturers must report international pricing data yearly or face a $10,000-a-day fine and eventual permit suspension.
Health insurers, HMOs, and small-group carriers must cap what they pay for a covered drug at the reference price, and must funnel the savings into lower premiums and cost sharing.
Insurers and HMOs can't drop a drug a patient is already taking or move it to a pricier tier mid-year, except for safety recalls, discontinuation, or new over-the-counter status; pharmacy benefit managers face new limits on self-dealing and underpaying independent pharmacies.
AIA pharmacy cannot charge a cash-paying customer more for a prescribed drug or biological product than the state's reference price once one is set; the cap covers only the drug itself, not the dispensing fee.
AIPrescription drug manufacturer permitholders, including nonresident ones, must annually report actual outpatient prices paid in reference-price source countries to AHCA starting October 1, 2026.
AIA health insurer offering outpatient drug coverage must reimburse a covered prescription drug at no more than its reference price once one exists, though dispensing and administration fees fall outside the cap.
AIOnce a patient starts a covered drug, an insurer generally cannot remove it from the formulary or move it to a costlier tier before the next annual renewal, apart from listed safety, discontinuance, or OTC exceptions.
AIMissing the international price-reporting deadline triggers a $10,000-a-day fine for the first month, then suspension of the manufacturer's Florida permit until it complies.
AIInsurers must channel the savings produced by reference pricing into lower premiums and cost sharing for policyholders, and document the anticipated savings in their rate filings.
AIA pharmacy benefit manager's formulary cannot force patients onto a drug made by a manufacturer affiliated with the PBM when a generic or interchangeable biosimilar is available.
AIA pharmacy benefit manager cannot pay an independent pharmacy less than it pays a pharmacy affiliated with the PBM itself for the same drug.