SB1084- Relating to Health Care Protocols
On Monday, February 1st, SB 1084, relating to Health Care Protocols, by Senator Don Gaetz (R-Destin) was heard by the Senate Health Policy Committee and passed with 9 yeas and 0 nays. AIF’s Vice President of State and Federal Affairs, Brewster Bevis, stood in opposition to this bill.

SB 1084 requires Medicaid managed care plans, health maintenance organizations (HMOs), and insurers that restrict medications by a step-therapy or fail-first protocol to have a clear and convenient process to request an override of the protocol. The bill requires these entities to grant an override of the protocol within 24 hours if, based on sound clinical evidence or medical and scientific evidence, the prescribing provider:

• Concludes that the preferred treatment required under the fail-first protocol has been ineffective in the treatment of the enrollee’s disease or medical condition; or
• Believes that the preferred treatment required under the fail-first protocol is likely to be ineffective given the known relevant physical or mental characteristics and medical history of the enrollee and the known characteristics of the drug regimen or will cause or is likely to cause an adverse reaction or other physical harm to the enrollee.

AIF believes this action to be redundant and unnecessary given that insurers already have a protocol in place if incidents, such as ineffective treatment of the enrollee’s disease or medical condition, occurs.

This bill will now go to its final committee stop in the Senate Appropriations Committee.

AIF opposes legislation that will negatively impact the standards of care that are currently in place based on real-time protocols that are centered on evidence-based research.

Please see below a statement released by Tammy Perdue regarding AIF’s opposition to SB 1084:

AIF Statement in Opposition of Step Therapy Legislation Passed Today
by the Senate Health Policy Committee

Tallahassee, Fla. – The Associated Industries of Florida (AIF) today released the following statement attributed to its General Counsel Tamela Perdue in opposition to Senate Bill 1084, which would change the current, effective method of prior authorization, step therapy and fail-first protocols.

“AIF stands in opposition of SB 1084, which passed the Senate Health Policy Committee today, because it negatively impacts the current effective system of prior authorization and step therapy protocols.  Ultimately, if passed, this legislation would increase pharmaceutical costs, as well as fail to provide safeguards that Florida insurers have in place against abuse and adverse drug interactions.

“AIF continues to support flexibility for health plans, which ensures consumers receive high-quality, high-value and affordable care, through the continued use of innovative plan designs to achieve this balance.  We hope lawmakers stand up against this bad public policy as it heads to Senate Appropriations, as it will only increase costs and not serve Florida consumers.”     

Senate Bill 1084 has also been referred to the Senate Committee on Appropriations.

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SB 1442-Relating to Out-of-network Health Insurance Coverage
On Monday, February 1st, SB 1442, relating to Out-of-network Health Insurance Coverage, by Senator Rene Garcia (R-Hialeah) was heard by the Senate Health Policy Committee and passed by a narrow vote of 5 yeas to 4 nays. AIF’s Senior Vice President of State and Federal Affairs, Brewster Bevis, stood in support of this bill.

The intent of this bill is to protect consumers from balance billing when that situation occurs in an emergency setting; the balance bill is the difference between the provider's charges and the amount the provider has received in reimbursement from the consumer's insurance plan. Provider charges in Florida are often 100 times more than Medicaid charges, so this legislation should cap a significant cost driver in today's health care system. 

With the adoption of Amendment 976590, by Senator Rene Garcia (R-Hialeah), AIF supports this bill. The amendment provides that balance billing is prohibited by Florida law; this is applicable under emergency in out of network areas, or in the service network if the patient did not have the option to select their physician. Existing HMO reimbursement standards will remain in place.

The next committee stop for SB 1442 will be in the Senate Banking and Insurance Committee.

AIF supports legislation that requires a patient to be presented with documentation regarding any charges for out-of-network services.