Florida Statute 627.6572 - Full Text and Legal Analysis

627.6572 Pharmacy benefit manager contracts.—

(1) As used in this section, the term:

(a) “Maximum allowable cost” means the per-unit amount that a pharmacy benefit manager reimburses a pharmacist for a prescription drug, excluding dispensing fees, prior to the application of copayments, coinsurance, and other cost-sharing charges, if any.

(b) “Pharmacy benefit manager” means a person or entity doing business in this state which contracts to administer or manage prescription drug benefits on behalf of a health insurer to residents of this state.

(2) In addition to the requirements of part VII of chapter 626, a contract between a health insurer and a pharmacy benefit manager must require that the pharmacy benefit manager:

(a) Update maximum allowable cost pricing information at least every 7 calendar days.

(b) Maintain a process that will, in a timely manner, eliminate drugs from maximum allowable cost lists or modify drug prices to remain consistent with changes in pricing data used in formulating maximum allowable cost prices and product availability.

(3) This section applies to contracts entered into or renewed on or after July 1, 2018.

History.—s. 5, ch. 2018-91; s. 17, ch. 2023-29.

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This Florida statute resource is curated by Graham Syfert, a Jacksonville, Florida personal injury and workers' compensation attorney (Florida Bar No. 39104). Attorney Syfert regularly handles Chapter 627 matters in the context of insurance coverage law and represents clients throughout Northeast Florida. For legal consultation, call 904-383-7448.