HB 697 — Drug Prices and Coverage

F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 6,697 Engrossed 1 2026 A bill to be entitled An act relating to drug prices and coverage;

providing an appropriationeffective fordate. implementation of the Ryan White Part B AIDS Drug Assistance Program (ADAP) through a specified date;

defining the term "low income" for purposes of ADAP eligibility through a specified date;

providing requirements for the implementation of ADAP through a specified date;

requiring the Department of Health to submit monthly reports providing a detailed accounting of ADAP to the Governor's Office of Policy and Budget and the chairs of the legislative appropriations committees;

specifying requirements for the reports;

requiring the department to adopt emergency rules to implement ADAP;

providing that such emergency rules are exempt from specified rulemaking requirements and remain in effect through a specified Page 1 of 8 CODING:

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hb697 -02-e1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 6, Engrossed 1 2026 date;

providing effective dates.

(u) "Pharmacy benefits plan or program" means a plan or program that pays for, reimburses, covers the cost of, or provides access to discounts on pharmacist services provided by one or more pharmacies to covered persons who reside in, are employedPage by,1 orof receive5 pharmacistCODING: services from this state.

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hb697-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 697 2026 employed by, or receive pharmacist services from this state.

Page(3) 2CONTRACTS BETWEEN A PHARMACY BENEFIT MANAGER AND A PARTICIPATING PHARMACY.—In addition to other requirements in the Florida Insurance Code, a participation contract executed, amended, adjusted, or renewed on or after July 1, 2023, that applies to pharmacist services on or after January 1, 2024, between a pharmacy benefit manager and one or more pharmacies or pharmacists, must include, in substantial form, terms that ensure compliance with all of 8the CODING:following requirements, and that, except to the extent not allowed by law, shall supersede any contractual terms in the participation contract to the contrary:

(h) The pharmacy benefit manager shall provide a reasonable administrative appeal procedure to allow a pharmacy or pharmacist to challenge the maximum allowable cost pricing Page 2 of 5 CODING:

hb697hb697-01-c1 -02-e1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 6,697 Engrossed 1 2026 (3)information CONTRACTS BETWEEN A PHARMACY BENEFIT MANAGER AND A PARTICIPATING PHARMACY.—In addition to other requirements in the Florida Insurance Code, a participation contract executed, amended, adjusted, or renewed on or after July 1, 2023, that applies to pharmacist services on or after January 1, 2024, between a pharmacy benefit manager and one or more pharmacies or pharmacists, must include, in substantial form, terms that ensure compliance with all of the followingreimbursement requirements,made andunder that, except to the extentmaximum notallowable allowedcost byas law,defined shall supersede any contractual terms in thes. participation contract to the contrary:

(h) The pharmacy benefit manager shall provide a reasonable administrative appeal procedure to allow a pharmacy or pharmacist to challenge the maximum allowable cost pricing information and the reimbursement made under the maximum allowable cost as defined in s.

The administrative appeal procedure must allow a pharmacy or pharmacist the option to Pagesubmit 3a consolidated administrative appeal representing multiple adjudicated claims that share the same drug and day supply and have a date of 8service CODING:occurring within the same calendar month.

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words underlined are additions.

hb697 -02-e1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB , Engrossed 1 2026 submit a consolidated administrative appeal representing multiple adjudicated claims that share the same drug and day supply and have a date of service occurring within the same calendar month.

b.Page 3 of 5 CODING:

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hb697-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 697 2026 b.

If the appeal is denied, the pharmacy benefit manager must provide to the pharmacy or pharmacist the national drug code and the name of the national or regional pharmaceutical wholesalers operating in this state which have the drug Pagecurrently 4in ofstock 8at CODING:a price below the maximum allowable cost pricing information.

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hb697 -02-e1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB , Engrossed 1 2026 currently in stock at a price below the maximum allowable cost pricing information.

(8) Prohibit or restrict a pharmacy or pharmacist from declining to dispense a drug if the reimbursement rate is less thanPage the4 actualof acquisition5 costCODING: incurred or would be incurred by the pharmacy or pharmacist.

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hb697-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 697 2026 than the actual acquisition cost incurred or would be incurred by the pharmacy or pharmacist.

ForThis theact 2025-2026shall fiscaltake year,effect theJuly nonrecurring1, sum of $30,901,933 from the Grants and Donations Trust Fund is appropriated to the Department of Health for implementation of the Ryan White Part B AIDS Drug Assistance Program (ADAP) through June 30, 2026.

(1) For purposes of ADAP eligibility through June 30, Page 5 of 85 CODING:

hb697hb697-01-c1 -02-e1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB , Engrossed 1 2026 2026, the term "low income" means an adjusted gross household income at or below 400 percent of the federal poverty level.

(2) Through June 30, 2026, ADAP services may not be provided through or by the purchase of health insurance that includes coverage for HIV/AIDS medications but must be provided through the distribution of medications directly to eligible individuals.