Two Florida lawmakers want health insurance companies to stick by their contracts when it comes to prescription medications.
Currently, no law prevents health insurance companies from increasing a member's out-of-pocket prescription costs or changing the drugs they cover after the contract is signed.
Michael Ruppal is the Tampa-based executive director of The AIDS Institute, which leads Floridians for Reliable Health Coverage. That's a coalition of consumer and provider groups that back the bill from Sen. Debbie Mayfield and Rep. Ralph Massullo.
He said the newly filed "Bait and Switch" bill (SB 182/HB 95) makes sure consumers don't deal with unforeseen coverage changes during their contract.
"It really is a patient protection bill,” Ruppal said. “It is not an anti-insurance bill. It is not a mandate. It's literally just having the insurers honor what they say the day the person signs up with their plan until the end of their term, which is usually one year."
It could help consumers who need specific medications stay covered throughout a contract year.
“I hear from constituents who sign up for a plan that covers the medicine they need, only to have their health plan force them to switch to a less effective drug just a few months later,” Mayfield said in a news release. “The ‘Bait-and-Switch Bill’ is about consumer protection. All we want is for Florida insurers to honor their contracts with patients. Floridians can’t change health plans throughout the year, so insurers shouldn’t be able to reduce the benefits they receive.”
Ruppal said the nation’s two largest pharmacy benefit managers – Express Scripts and CVS/Caremark, which set the coverage for many health insurers – recently announced additional drugs that they aren’t covering in 2017, bringing their total of excluded products to 124 and 154, respectively.
“As a physician, I know just how important it is to keep medical decisions between health care providers and patients,” Massullo said in a news release. “By reducing prescription drug coverage during the health plan year, insurers are pressuring patients onto different medications and essentially playing doctor. But when insurance companies make the medical decisions, patients can lose control of their disease and wind up in the hospital or worse.”
The bill would give some flexibility for insurers to add brand and generic medications to their formularies, or make coverage changes if the FDA announces drug safety concerns.