FLORIDA SUMMARY OF EXISTING LAW

A contract between a health insurer and PBM is prohibited from requiring a payment for a prescription at the point-of-sale that exceeds the lesser of the applicable cost-sharing amount or the retail price of the drug in the absence of prescription drug coverage. This applies to contracts entered into or renewed on or after July 1, 2018.

Link to Existing Law: FL ST § 627.6572(4)

PRACTICAL NOTE

While this law does not apply directly to DIR fees, it would prevent post-point-of-sale clawbacks when the patient’s copayment amount is greater than the amount the pharmacy stands to retain.