Florida Statutes 626.8827 – Pharmacy benefit manager prohibited practices
Current as of: 2023 | Check for updates
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In addition to other prohibitions in this part, a pharmacy benefit manager may not do any of the following:
(1) Prohibit, restrict, or penalize in any way a pharmacy or pharmacist from disclosing to any person any information that the pharmacy or pharmacist deems appropriate, including, but not limited to, information regarding any of the following:
(a) The nature of treatment, risks, or alternatives thereto.
Terms Used In Florida Statutes 626.8827
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Contract: A legal written agreement that becomes binding when signed.
- Fraud: Intentional deception resulting in injury to another.
- Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
- person: includes individuals, children, firms, associations, joint adventures, partnerships, estates, trusts, business trusts, syndicates, fiduciaries, corporations, and all other groups or combinations. See Florida Statutes 1.01
(b) The availability of alternate treatment, consultations, or tests.
(c) The decision of utilization reviewers or similar persons to authorize or deny pharmacist services.
(d) The process used to authorize or deny pharmacist services or benefits.
(e) Information on financial incentives and structures used by the pharmacy benefits plan or program.
(f) Information that may reduce the costs of pharmacist services.
(g) Whether the cost-sharing obligation exceeds the retail price for a covered prescription drug and the availability of a more affordable alternative drug, pursuant to s. 465.0244.
(2) Prohibit, restrict, or penalize in any way a pharmacy or pharmacist from disclosing information to the office, the Agency for Health Care Administration, the Department of Management Services, law enforcement, or state and federal governmental officials, provided that the recipient of the information represents it has the authority, to the extent provided by state or federal law, to maintain proprietary information as confidential; and before disclosure of information designated as confidential, the pharmacist or pharmacy marks as confidential any document in which the information appears or requests confidential treatment for any oral communication of the information.
(3) Communicate at the point-of-sale, or otherwise require, a cost-sharing obligation for the covered person in an amount that exceeds the lesser of:
(a) The applicable cost-sharing amount under the applicable pharmacy benefits plan or program; or
(b) The usual and customary price, as defined in s. 626.8825, of the pharmacist services.
(4) Transfer or share records relative to prescription information containing patient-identifiable or prescriber-identifiable data to an affiliated pharmacy for any commercial purpose other than the limited purposes of facilitating pharmacy reimbursement, formulary compliance, or utilization review on behalf of the applicable pharmacy benefits plan or program.
(5) Fail to make any payment due to a pharmacy for an adjudicated claim with a date of service before the effective date of a pharmacy’s termination from a pharmacy benefit network unless payments are withheld because of fraud on the part of the pharmacy or except as otherwise required by law.
(6) Terminate the contract of, penalize, or disadvantage a pharmacist or pharmacy due to a pharmacist or pharmacy:
(a) Disclosing information about pharmacy benefit manager practices in accordance with this act;
(b) Exercising any of its prerogatives under this part; or
(c) Sharing any portion, or all, of the pharmacy benefit manager contract with the office pursuant to a complaint or a query regarding whether the contract is in compliance with this act.