New Laws Regulate Paid Family Leave Insurance and Pharmacy Benefits

Gov. DeSantis recently signed the following bills into law:

HB 721, as enacted, amends the insurance laws to specify standards for transacting paid family leave insurance in Florida. The state does not require employers to provide paid family leave, but HB 721 allows insurers to provide paid family leave coverage for an employer wishing to offer such leave.

Specifically, life insurers may transact paid family leave insurance as a policy or as a rider to a group disability income policy. Further, HB 721 specifies circumstances under which paid family leave insurance benefits may be provided, and it also requires paid family leave insurance policies or riders to include disclosures and coverage requirements, such as benefit periods, waiting periods, benefit amounts, offsets and the payment of benefits.

HB 721 took effect upon becoming law, and rules will soon be issued to implement the law’s provisions.

HB 721 »

SB 1550, which is now known as the state’s Prescription Drug Reform Act (the “Act”), regulates the coverage of pharmacy benefits. The Act focuses on transparency, accountability and relationships within the outpatient pharmaceutical delivery system.

The Act creates a regulatory framework designed to address several important concerns regarding pharmacy benefit plans and pharmacy benefit managers (PBMs). PBMs operating in the state will be regulated as administrators under the Florida Insurance Code and required to comply with certain disclosure, financial reporting and contractual requirements.

Under the Act, contracts between PBMs and plans must require a PBM to reimburse a pharmacy using a pass-through model (meaning the full amount paid by the plan), thus prohibiting spread pricing unless the PBM passes along the entire amount of any difference to the plan. Additionally, any PBM-negotiated manufacturer rebate must be passed to the plan for offsetting defined cost-sharing and reducing premiums of covered persons. A PBM must also meet certain network adequacy requirements and provide a 60-day continuity-of-care period upon revising a formulary of covered prescription drugs during a plan year so that the covered drug continues to be provided to the covered patient at the same cost during the 60-day period.

The Act becomes effective July 1, 2023. The PBM contracting provisions apply to all contracts that are executed or amended after July 1, 2023, which apply to pharmacy benefits beginning on or after January 1, 2024. Rules will be issued to implement the Act’s provisions.

Employers should be aware of the new laws and monitor for further guidance.

SB 1550 »