Insurer Disclosures on Prescription Drug Coverage:
HB 899 would impose new disclosure, notice, reporting, and coverage rules on Florida health insurers, health maintenance organizations (HMOs), small employer carriers, and their pharmacy benefit managers for prescription drug coverage. The bill requires advance notice, generally 60 days before a formulary change takes effect, to current and prospective enrollees and to treating physicians, and it creates a process for a physician to certify that a drug is medically necessary so coverage can continue through the end of the policy or contract year. It also limits insurers and HMOs from increasing cost-sharing, moving a drug to a more restrictive tier, denying previously approved coverage, or adding new utilization management restrictions for a drug that is certified as medically necessary under the bill’s process.
The bill also addresses how prescription drug payments made by an insured or by someone on the insured’s behalf are counted toward deductibles, copayments, coinsurance, and other out-of-pocket cost-sharing requirements. For certain drugs, including non-generic drugs and drugs approved through prior authorization, step therapy, or an exception/appeal process, those payments would have to be applied toward the insured’s cost-sharing obligations. The bill defines “cost-sharing requirement,” requires insurers and HMOs to disclose these rules on their websites and in policy or contract materials, and requires annual reporting to the Office of Insurance Regulation on formulary changes and third-party payments. The office must compile the data and publish a public report for the Governor and Legislature. The bill applies to policies, plans, and contracts issued or renewed on or after January 1, 2026, and takes effect July 1, 2025.
HB 899 would create new sections in the Florida Insurance Code governing prescription drug formulary changes and cost-sharing treatment for individual and group health insurance, HMO contracts, and related pharmacy benefit manager agreements. It would also amend existing provisions for small employer carriers, HMO subscriber protections, and Medicaid managed care transparency cross-references. In practical terms, the bill would require insurers and HMOs to change notice procedures, maintain records, submit annual reports, and honor certain third-party prescription drug payments toward patient cost-sharing, while limiting midyear formulary changes for medically necessary drugs. The bill would affect insurers, HMOs, PBMs, policyholders, subscribers, physicians, and the Office of Insurance Regulation.
The available context suggests the bill was generally aimed at consumer protection and transparency in prescription drug coverage, with a focus on preventing abrupt formulary changes and ensuring that patient assistance payments count toward out-of-pocket limits. Because there are no committee transcripts or recorded votes provided, there is no direct evidence of debate tone or bipartisan support in the materials. The bill ultimately died in the Insurance & Banking Subcommittee, indicating it did not advance despite its consumer-facing policy goals.
The main points of contention likely involve the bill’s impact on insurer and PBM formulary management, pricing practices, and the handling of manufacturer copay assistance or other third-party payments. Insurers and pharmacy benefit managers may object to restrictions on midyear formulary changes, the requirement to continue coverage through the end of the year after a medical-necessity certification, and the mandate to count certain third-party payments toward deductibles and out-of-pocket maximums. Supporters would likely emphasize patient access, continuity of care, and transparency, while opponents may argue the bill could increase premiums, reduce formulary flexibility, or complicate benefit administration. No specific named opponents or supporters are identified in the provided record.