Florida among several states confronting drug formulary questions
March 17, 2017
By Erin Clark | Florida Politics
Some of the largest states in the union are considering legislation that would block insurers and pharmacy benefit managers from dropping covered drugs outside the normal sign-up period.
In Florida, HB 95 was introduced by state Rep. Ralph Massullo to prevent a drug being dropped from a formulary, or moved to a higher-priced tier, in the middle of the insurance plan year. Similar bans are under consideration in Illinois and New York, among other states.
A formulary is a set of drugs that insurers and pharmacy benefit managers (PBMs) arrange in different cost and coverage tiers. Patients can expect their direct costs to reflect a drug’s formulary designation. However, insurers and PBMs have the ability to adjust a drug formulary midyear.