627.42393 - Step-therapy protocol.

FL Stat § 627.42393 (2019) (N/A)

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(1) A health insurer issuing a major medical individual or group policy may not require a step-therapy protocol under the policy for a covered prescription drug requested by an insured if:

(a) The insured has previously been approved to receive the prescription drug through the completion of a step-therapy protocol required by a separate health coverage plan; and

(b) The insured provides documentation originating from the health coverage plan that approved the prescription drug as described in paragraph (a) indicating that the health coverage plan paid for the drug on the insured’s behalf during the 90 days immediately before the request.

(2) As used in this section, the term “health coverage plan” means any of the following which is currently or was previously providing major medical or similar comprehensive coverage or benefits to the insured:

(a) A health insurer or health maintenance organization.

(b) A plan established or maintained by an individual employer as provided by the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406.

(d) A governmental entity providing a plan of self-insurance.

(3) This section does not require a health insurer to add a drug to its prescription drug formulary or to cover a prescription drug that the insurer does not otherwise cover.

History.—s. 12, ch. 2019-138.

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627.42392 - Prior authorization.

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627.42395 - Coverage for certain prescription and nonprescription enteral formulas.