2023 - 2024 LEGISLATURE
ASSEMBLY AMENDMENT 1,
TO ASSEMBLY BILL 773
February 12, 2024 - Offered by Representative Schraa.
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5“
Section 11m. 632.861 (5) of the statutes is created to read:
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632.861
(5) Continuity of care. (a) In this subsection:
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1. “Demonstrated bioavailability” means the rate and extent of absorption of
8a drug or drug ingredient from a specified dosage form, as reflected by the
9time-concentration curve of the drug or drug ingredient in the systemic circulation.
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2. “Interchangeable biological product” has the meaning given in s. 450.135 (1).
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(b) With respect to a disability insurance policy that offers a prescription drug
12benefit, a self-insured health plan that offers a prescription drug benefit, or a
1pharmacy benefit manager acting on behalf of a disability insurance policy or
2self-insured health plan, all of the following apply:
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1. No disability insurance policy, self-insured health plan, or pharmacy benefit
4manager acting on behalf of a disability insurance policy or self-insured health plan
5may impose any limitations or exclusions of coverage of a prescription drug for any
6insured who is medically stable on the prescription drug as determined by the
7prescribing health care provider if all of the following apply:
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a. The prescription drug was previously approved for coverage for the insured
9under the policy or plan.
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b. The insured continues to be an enrollee under the policy or plan.
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2. Coverage of a prescription drug, as described in subd. 1., shall continue
12through the last day of the insured's eligibility under the policy or plan, or through
13the last day of the plan year, whichever is earlier.
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(c) For purposes of par. (b) 1., prohibited limitations and exclusions include all
15of the following:
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1. Limiting or reducing the maximum coverage of prescription drug benefits.
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2. Increasing cost-sharing for a covered prescription drug.
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3. Moving a prescription drug to a more restrictive tier if the policy or plan uses
19a formulary with tiers.
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4. Removing a prescription drug from the formulary, unless the federal food and
21drug administration has issued a statement about the prescription drug that calls
22into question the clinical safety of the prescription drug, or the manufacturer of the
23prescription drug has notified the federal food and drug administration of a
24manufacturing discontinuance or potential manufacturing discontinuance of the
25prescription drug as required under
21 USC 356c.
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1(d) Paragraphs (b) and (c) may not be construed to prohibit a substitution,
2formulary change, or preference for a prescription drug by a disability insurance
3policy, self-insured health plan, or pharmacy benefit manager acting on behalf of a
4disability insurance policy or self-insured health plan that has the same generic
5name and demonstrated bioavailability or that is an interchangeable biological
6product.
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(e) This subsection may not be construed to do any of the following:
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1. Prevent a health care provider from prescribing another drug covered by the
9disability insurance policy or self-insured health plan that the health care provider
10deems medically necessary for the insured.
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2. Prevent a disability insurance policy, self-insured health plan, or pharmacy
12benefit manager acting on behalf of a disability insurance policy or self-insured
13health plan from doing any of the following:
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a. Adding a prescription drug to its formulary.
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b. Removing a prescription drug from its formulary if the drug manufacturer
16has removed the drug from sale in the United States.”.
