(1)It is unlawful for any person to act as or hold himself or herself out to be an administrator in this state without a valid certificate of authority issued by the office pursuant to ss. 626.88-626.894. A pharmacy benefit manager that is registered with the office under s. 624.490 as of June 30, 2023, may continue to operate until January 1, 2024, as an administrator without a certificate of authority and is not in violation of the requirement to possess a valid certificate of authority as an administrator during that timeframe. To qualify for and hold authority to act as an administrator in this state, an administrator must otherwise be in compliance with this code and with its organizational agreement. The failure of any person, excluding a pharmacy benefit manager, to hold such a cer
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(1) It is unlawful for any person to act as or hold himself or herself out to be an administrator in this state without a valid certificate of authority issued by the office pursuant to ss. 626.88-626.894. A pharmacy benefit manager that is registered with the office under s. 624.490 as of June 30, 2023, may continue to operate until January 1, 2024, as an administrator without a certificate of authority and is not in violation of the requirement to possess a valid certificate of authority as an administrator during that timeframe. To qualify for and hold authority to act as an administrator in this state, an administrator must otherwise be in compliance with this code and with its organizational agreement. The failure of any person, excluding a pharmacy benefit manager, to hold such a certificate while acting as an administrator shall subject such person to a fine of not less than $5,000 or more than $10,000 for each violation. A person who, on or after January 1, 2024, does not hold a certificate of authority to act as an administrator while operating as a pharmacy benefit manager is subject to a fine of $10,000 per violation per day. By January 15, 2024, the office shall submit to the Governor, the President of the Senate, and the Speaker of the House of Representatives a report detailing whether each pharmacy benefit manager operating in this state on January 1, 2024, obtained a certificate of authority on or before that date as required by this section.
(2) The administrator shall file with the office an application for a certificate of authority upon a form to be adopted by the commission and furnished by the office, which application shall include or have attached the following information and documents: (a) All basic organizational documents of the administrator, such as the articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, shareholder agreement, and other applicable documents, and all amendments to those documents. (b) The bylaws, rules, and regulations or similar documents regulating the conduct or the internal affairs of the administrator. (c) The names, addresses, official positions, and professional qualifications of the individuals employed or retained by the administrator who are responsible for the conduct of the affairs of the administrator, including all members of the board of directors, board of trustees, executive committee, or other governing board or committee, and the principal officers in the case of a corporation or the partners or members in the case of a partnership or association of the administrator. (d) Audited annual financial statements for the 2 most recent fiscal years which prove that the applicant has a positive net worth. If the applicant has been in existence for less than 2 fiscal years, the application must include financial statements or reports, certified by an officer of the applicant and prepared in accordance with GAAP, for any completed fiscal years and for any month during the current fiscal year for which such financial statements or reports have been completed. An audited financial statement or report prepared on a consolidated basis must include a columnar consolidating or combining worksheet that shall be filed with the report and must comply with the following: 1. Amounts shown on the consolidated audited financial report must be shown on the worksheet; 2. Amounts for each entity shall be stated separately; and 3. Explanations of consolidating and eliminating entries. The applicant shall also include such other information as the office requires in order to review the current financial condition of the applicant. (e) A statement describing the business plan, including information on staffing levels and activities proposed in this state and nationwide. The plan must provide details setting forth the applicant’s capability for providing a sufficient number of experienced and qualified personnel in the areas of claims processing, recordkeeping, and underwriting. (f) If the applicant is not currently acting as an administrator, a statement of the amounts and sources of the funds available for organization expenses and the proposed arrangements for reimbursement and compensation of incorporators or other principals.
(3) An applicant that is a pharmacy benefit manager must also submit all of the following: (a) A complete biographical statement on forms prescribed by the commission. (b) An independent background report as prescribed by the commission. (c) A full set of fingerprints of all of the individuals referenced in paragraph (2)(c) to the office or to a vendor, entity, or agency authorized by s. 943.053(13). The office, vendor, entity, or agency, as applicable, shall forward the fingerprints to the Department of Law Enforcement for state processing, and the Department of Law Enforcement shall forward the fingerprints to the Federal Bureau of Investigation for national processing in accordance with s. 943.053 and 28 C.F.R. s. 20. (d) A self-disclosure of any administrative, civil, or criminal complaints, settlements, or discipline of the applicant, or any of the applicant’s affiliates, which relate to a violation of the insurance laws, including pharmacy benefit manager laws, in any state. (e) A statement attesting to compliance with the network requirements in s. 626.8825 beginning January 1, 2024.
(4)(a) The applicant shall make available for inspection by the office copies of all contracts relating to services provided by the administrator to insurers or other persons using the services of the administrator. (b) An applicant that is a pharmacy benefit manager shall also make available for inspection by the office: 1. Copies of all contract templates with any pharmacy as defined in s. 465.003; and 2. Copies of all subcontracts to support its operations.
(5) The office shall not issue a certificate of authority if it determines that the administrator or any principal thereof is not competent, trustworthy, financially responsible, or of good personal and business reputation or has had an insurance license denied for cause by any state.
(6) A certificate of authority issued under this section shall remain valid, unless suspended or revoked by the office, so long as the certificateholder continues in business in this state.
(7) A certificate of authority issued under this section shall indicate that the administrator is authorized to administer commercial self-insurance funds or life and health programs or both, except that a certificate of authority issued prior to October 1, 1988, does not authorize the administration of commercial self-insurance funds.
(8) A pharmacy benefit manager is exempt from fees associated with the initial application and the annual filing fees in s. 626.89.