Online Sunshine Logo
Official Internet Site of the Florida Legislature
October 1, 2020
Text: 'NEW Advanced Legislative Search'
Interpreter Services for the Deaf and Hard of Hearing
Go to MyFlorida House
Go to MyFlorida House
Select Year:  
The Florida Statutes

The 2019 Florida Statutes

Title XXXVII
INSURANCE
Chapter 627
INSURANCE RATES AND CONTRACTS
View Entire Chapter
F.S. 627.42393
627.42393 Step-therapy protocol.
(1) A health insurer issuing a major medical individual or group policy may not require a step-therapy protocol under the policy for a covered prescription drug requested by an insured if:
(a) The insured has previously been approved to receive the prescription drug through the completion of a step-therapy protocol required by a separate health coverage plan; and
(b) The insured provides documentation originating from the health coverage plan that approved the prescription drug as described in paragraph (a) indicating that the health coverage plan paid for the drug on the insured’s behalf during the 90 days immediately before the request.
(2) As used in this section, the term “health coverage plan” means any of the following which is currently or was previously providing major medical or similar comprehensive coverage or benefits to the insured:
(a) A health insurer or health maintenance organization.
(b) A plan established or maintained by an individual employer as provided by the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406.
(c) A multiple-employer welfare arrangement as defined in s. 624.437.
(d) A governmental entity providing a plan of self-insurance.
(3) This section does not require a health insurer to add a drug to its prescription drug formulary or to cover a prescription drug that the insurer does not otherwise cover.
History.s. 12, ch. 2019-138.