¹110.12315 Prescription drug program.--

The state employees' prescription drug program is established. This program shall be administered by the Department of Management Services, according to the terms and conditions of the plan as established by the relevant provisions of the annual General Appropriations Act and implementing legislation, subject to the following conditions:

1. (1) The Department of Management Services shall allow prescriptions written by health care providers under the plan to be filled by any licensed pharmacy pursuant to contractual claims-processing provisions. Nothing in this section may be construed as prohibiting a mail order prescription drug program distinct from the service provided by retail pharmacies.

2. (2) In providing for reimbursement of pharmacies for prescription medicines dispensed to members of the state group health insurance plan and their dependents under the state employees' prescription drug program:

   1. (a) Retail pharmacies participating in the program must be reimbursed at a uniform rate and subject to uniform conditions, according to the terms and conditions of the plan.
   2. (b) There shall be a 30-day supply limit for prescription card purchases and 90-day supply limit for mail order or mail order prescription drug purchases.
   3. (c) The current pharmacy dispensing fee remains in effect.
3. (3) The Department of Management Services shall establish the reimbursement schedule for prescription pharmaceuticals dispensed under the program. Reimbursement rates for a prescription pharmaceutical must be based on the cost of the generic equivalent drug if a generic equivalent exists, unless the physician prescribing the pharmaceutical clearly states on the prescription that the brand name drug is medically necessary or that the drug product is included on the formulary of drug products that may not be interchanged as provided in chapter 465, in which case reimbursement must be based on the cost of the brand name drug as specified in the reimbursement schedule adopted by the Department of Management Services.
4. (4) The Department of Management Services shall conduct a prescription utilization review program. In order to participate in the state employees' prescription drug program, retail pharmacies dispensing prescription medicines to members of the state group health insurance plan or their covered dependents, or to subscribers or covered dependents of a health maintenance organization plan under the state group insurance program, shall make their records available for this review.
5. (5) The Department of Management Services shall implement such additional cost-saving measures and adjustments as may be required to balance program funding within appropriations provided, including a trial or starter dose program and dispensing of long-term-maintenance medication in lieu of acute therapy medication.
6. (6) Participating pharmacies must use a point-of-sale device or an on-line computer system to verify a participant's eligibility for coverage. The state is not liable for reimbursement of a participating pharmacy for dispensing prescription drugs to any person whose current eligibility for coverage has not been verified by the state's contracted administrator or by the Department of Management Services.

7. (7) Under the state employees' prescription drug program copayments must be made as follows:

   1. (a) Effective January 1, 2004, through December 31, 2005:

      1. For generic drug with card ............ $10.

      2. For preferred brand name drug with card ............ $25.

      3. For nonpreferred brand name drug with card ............ $40.

      4. For generic mail order drug ............ $20.

      5. For preferred brand name mail order drug ............ $50.

      6. For nonpreferred brand name mail order drug ............ $80.

   2. (b) Effective January 1, 2006, through December 31, 2006, for the State Group Health Insurance Standard Plan:

      1. For generic drug with card ............ $10.

      2. For preferred brand name drug with card ............ $25.

      3. For nonpreferred brand name drug with card ............ $40.

      4. For generic mail order drug ............ $20.

      5. For preferred brand name mail order drug ............ $50.

      6. For nonpreferred brand name mail order drug ............ $80.

   3. (c) Effective January 1, 2006, through December 31, 2006, for the State Group Health Insurance High Deductible Plan:

      1. Retail coinsurance for generic drug with card ............ 30%.

      2. Retail coinsurance for preferred brand name drug with card ............ 30%.

      3. Retail coinsurance for nonpreferred brand name drug with card ............ 50%.

      4. Mail order coinsurance for generic drug ............ 30%.

      5. Mail order coinsurance for preferred brand name drug ............ 30%.

      6. Mail order coinsurance for nonpreferred brand name drug ............ 50%.

   4. (d) The Department of Management Services shall create a preferred brand name drug list to be used in the administration of the state employees' prescription drug program.

      ¹Note.--Section 8, ch. 99-255, provides that "[t]he Department of Management Services shall not implement a prior authorization program or a restricted formulary program that restricts a non-HMO enrollee's access to prescription drugs beyond the provisions of [subsection (3)] related specifically to generic equivalents for prescriptions and the provisions in [subsection (5)] related specifically to starter dose programs or the dispensing of long-term maintenance medications. The prior authorization program expanded pursuant to section 8 of the 1998-1999 General Appropriations Act is hereby terminated. If this section conflicts with any General Appropriations Act or any act implementing a General Appropriations Act, the Legislature intends that the provisions of this section shall prevail. This section shall take effect upon becoming law."

History.--s. 53, ch. 92-69; s. 32, ch. 96-399; s. 4, ch. 97-92; ss. 37, 53, ch. 99-228; s. 7, ch. 99-255; s. 62, ch. 2000-171; s. 46, ch. 2001-254; s. 44, ch. 2002-402; s. 39, ch. 2003-399; ss. 33, 76, ch. 2004-269; s. 1, ch. 2004-347; s. 4, ch. 2005-97.