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Health Care

A healthy and productive workforce is vital to Florida employers and the state’s economy as a whole. To ensure a thriving Florida workforce, AIF will focus its efforts on proposals that seek to increase the accessibility and affordability of quality health care for Florida residents. Further, AIF will continue to encourage the legislature to leverage available federal funding for delivering health care to more Floridians in a manner that best safeguards Florida’s citizens and protects the state’s financial health. The following topics represent the kinds of inventive solutions for which AIF will advocate during the 2020 Legislative Session.

Quality and Cost Protocols

Employers rely on insurers so that their employees receive access to the most clinically effective treatments. This allows employees to receive prompt, adequate care and be at work rather than at home or in the hospital. Currently, the many health insurance carriers in Florida employ robust policy product offerings containing medically proven prior-authorization and step-therapy programs. These policy product offerings are designed to reflect the protocols and standards of care advanced and adopted by a vast array of specialty physicians based on their latest evidence-based research. These procedures and protocols allow for the use of the safest, most appropriate and most cost-effective drugs and permit progressing to other, more costly drugs with more sophisticated interactions and side-effects, in accordance with FDA approvals. However, several legislative proposals have been initiated to dismantle this rational, cost-effective and care-improving protocol, which would force insurers and consumers to purchase the most expensive drugs and treatments even when equally effective therapies are available at much lower costs. The use of specialty pharmacies, drug formularies, and cost-sharing incentives are examples of benefit designs that have helped and should be permitted to continue to help patients get the care they need while keeping their coverage affordable.

AIF SUPPORTS continued flexibility for health plans to ensure consumers receive high quality, high value, and affordable care, through continued use of innovative plan designs.

AIF SUPPORTS modernizing the prior-authorization and step-therapy processes by requiring the use of electronic transmission of authorization requests.

AIF SUPPORTS requiring pharmacies to notify insurers when a drug coupon is used to process a claim as well as how much the coupon requires a consumer to pay for the drug.

AIF OPPOSES efforts to restrict health plans from using step-therapy and prior-authorization to control costs and improve quality.

Health Care Workforce

Florida is now the third most populous state in the nation, and our residents reflect diversity in age, income, talent and health care needs. Almost one-fourth of the state’s physicians are age 60 or older and will retire or cut back their practice within the next 10 years. These statistics illustrate the need to increase our health care workforce.

AIF SUPPORTS increasing the number of graduate medical education slots available in Florida and urges consideration of other available workforce resources that are currently underutilized.

AIF SUPPORTS removing regulatory scope-of-practice obstacles for qualified health care professionals to ensure greater access to quality care for more Floridians at more affordable costs. Further, AIF will urge the legislature to encourage institutions of higher education to include technological advances in degree curriculum and recognize that private institutions of higher education significantly contribute to those health care professionals who serve our residents.

Retroactive Claims Denials

Currently in Florida, insurers pay claims for members who have paid their premiums. AIF OPPOSES legislation requiring insurers to pay claims for all people, even those that have not paid their premiums, because it:

  • TRIPLES the costly impact of the Obamacare grace period that allows people to use health insurance benefits they have not purchased
  • Raises costs on employers who would be required to pay health care expenses of people who are no longer employees.
  • Forces consumers to pay the high costs of fraud, waste and abuse that would occur in the system.
Pharmacy Benefit Managers

Florida businesses use pharmacy benefit managers (PBMs) to reduce the cost of drugs in their member health plans. AIF OPPOSES legislative attempts to lessen the effect of pharmacy benefit managers.