SB45,1397,1713(5) Transparency and reporting. (a) Beginning on January 1, 2027, an 14insurer shall annually publish a report detailing the insurer’s claim denial rates, 15reasons for claim denials, and the outcome of any appeal of a claim denial for the 16previous year for all disability insurance policies under which the insurer provides 17coverage. SB45,1397,1918(b) The commissioner shall maintain a public database of insurers’ claim 19denial rates and the outcomes of independent reviews under s. 632.835. SB45,1397,2320(c) Beginning on January 1, 2027, an insurer that uses artificial intelligence 21or algorithmic decision-making in claims processing shall annually publish a report 22detailing all of the following for the previous year for all disability insurance policies 23under which the insurer provides coverage: SB45,1398,2
11. The percentage of claims submitted to the insurer that were reviewed by 2artificial intelligence or algorithmic decision-making. SB45,1398,532. The claim denial rate of claims reviewed by artificial intelligence or 4algorithmic decision-making compared to the claim denial rate of claims reviewed 5by humans. SB45,1398,763. The steps the insurer takes to ensure fairness and accuracy in decisions 7made by artificial intelligence or algorithmic decision-making. SB45,1398,118(6) Claim denial rate audits. (a) The commissioner may conduct an audit 9of an insurer if the insurer’s claim denials are of such frequency as to indicate a 10general business practice. This paragraph is supplemental to and does not limit 11any other powers or duties of the commissioner. SB45,1398,1312(b) The commissioner may collect any relevant information from an insurer 13that is necessary to conduct an audit under par. (a). SB45,1398,1514(c) The commissioner may contract with a 3rd party to conduct an audit under 15par. (a). SB45,1398,2016(d) The commissioner may, based on the findings of an audit under par. (a), 17order the insurer who is the subject of the audit to comply with a corrective action 18plan approved by the commissioner. The commissioner shall specify in any 19corrective action plan under this paragraph the deadline by which an insurer must 20be in compliance with the corrective action plan. SB45,1398,2221(e) An insurer who is the subject of an audit under par. (a) shall provide a 22written response to any adverse findings of the audit. SB45,1399,223(f) If an insurer fails to comply with a corrective action plan under par. (d) by
1the deadline specified by the commissioner, the commissioner may order the 2insurer to pay a forfeiture pursuant to s. 601.64 (3). SB45,1399,63(7) Forfeitures. A violation of this section that results in a harmful delay in 4an insured’s care or an adverse health outcome for an insured shall be subject to a 5civil forfeiture of $10,000 per occurrence, in addition to any other penalties provided 6in s. 601.64 (3) or other law. SB45,28887Section 2888. 601.575 of the statutes is created to read: SB45,1399,138601.575 Prescription drug importation program. (1) Importation 9program requirements. The commissioner, in consultation with persons 10interested in the sale and pricing of prescription drugs and appropriate officials 11and agencies of the federal government, shall design and implement a prescription 12drug importation program for the benefit of residents of this state, that generates 13savings for residents, and that satisfies all of the following: SB45,1399,1614(a) The commissioner shall designate a state agency to become a licensed 15wholesale distributor or to contract with a licensed wholesale distributor and shall 16seek federal certification and approval to import prescription drugs. SB45,1399,1817(b) The program shall comply with relevant requirements of 21 USC 384, 18including safety and cost savings requirements. SB45,1399,2019(c) The program shall import prescription drugs from Canadian suppliers 20regulated under any appropriate Canadian or provincial laws. SB45,1399,2221(d) The program shall have a process to sample the purity, chemical 22composition, and potency of imported prescription drugs. SB45,1400,223(e) The program shall import only those prescription drugs for which 24importation creates substantial savings for residents of this state and only those
1prescription drugs that are not brand-name drugs and that have fewer than 4 2competitor prescription drugs in the United States. SB45,1400,43(f) The commissioner shall ensure that prescription drugs imported under the 4program are not distributed, dispensed, or sold outside of this state. SB45,1400,55(g) The program shall ensure all of the following: SB45,1400,761. Participation by any pharmacy or health care provider in the program is 7voluntary. SB45,1400,982. Any pharmacy or health care provider participating in the program has the 9appropriate license or other credential in this state. SB45,1400,12103. Any pharmacy or health care provider participating in the program charges 11a consumer or health plan the actual acquisition cost of the imported prescription 12drug that is dispensed. SB45,1400,1613(h) The program shall ensure that a payment by a health plan or health 14insurance policy for a prescription drug imported under the program reimburses no 15more than the actual acquisition cost of the imported prescription drug that is 16dispensed. SB45,1400,1817(i) The program shall ensure that any health plan or health insurance policy 18participating in the program does all of the following: SB45,1400,20191. Maintains a formulary and claims payment system with current 20information on prescription drugs imported under the program. SB45,1400,23212. Bases cost-sharing amounts for participants or insureds under the plan or 22policy on no more than the actual acquisition cost of the prescription drug imported 23under the program that is dispensed to the participant or insured.