Florida

Quick Facts

Key Provisions

• A Direct Primary Care agreement is explicitly defined as not being an insurance product and is therefore not subject to regulation under the Florida Insurance Code. This is the foundational provision of the state's DPC law.
• All DPC agreements must be in writing and must clearly describe the scope of primary care services that are covered by the periodic fee.
• The agreement must specify the exact periodic fee to be paid by the patient and the duration or term of the agreement.
• Practices must include a conspicuous, written disclosure in the agreement stating: 'This agreement is not health insurance and does not meet any individual health insurance mandate that may be required by federal law.'
• Either the patient or the provider may terminate the agreement at any time, provided they give at least 30 days' written notice to the other party.
• Upon termination of an agreement, the primary care provider is required to refund all periodic fees paid by the patient for any time period after the date of termination.
• The law defines a 'primary care provider' as a physician licensed under chapter 458 or 459, or a group practice composed of such physicians, clarifying who is eligible to offer DPC agreements.
• A DPC practice is not required to obtain a certificate of authority or any other license from the Office of Insurance Regulation to market, sell, or offer a DPC agreement.
• The written agreement must include the full name, business address, and contact information of the primary care provider or practice.
• The law protects DPC providers by stating that the Office of Insurance Regulation may not conduct examinations or audits of a DPC practice unless there is a reasonable belief of a violation of the insurance code unrelated to the DPC agreement itself.

Medication Dispensing

In Florida, DPC practices can significantly enhance patient care and affordability by dispensing medications directly from the clinic. This is permitted under Florida Statute § 465.0276, which governs 'Dispensing Practitioners.' To dispense medications, a physician must register with their respective licensing board (the Board of Medicine or Board of Osteopathic Medicine) and pay a registration fee. Registered dispensing practitioners must comply with specific regulations concerning the labeling, storage, and packaging of all drugs, similar to the standards required of a pharmacy. They are also subject to inspection by the Florida Department of Health. This framework allows DPC physicians to purchase medications wholesale and pass the savings on to their members, offering common generic drugs for a fraction of their typical retail cost and eliminating the need for a separate trip to the pharmacy.

Medicaid Provisions

Currently, Florida's Medicaid program does not have a formal, statewide structure for integrating Direct Primary Care services. The state's DPC legislation, HB 37, focuses on clarifying the model's legal status in the private market and does not include provisions for Medicaid pilot programs or waivers. As a result, DPC practices in Florida operate outside of the state's Medicaid managed care system, and membership fees cannot be paid for by Medicaid. While there is national interest in exploring DPC as a potential solution to improve access and outcomes for Medicaid populations, Florida has not yet implemented such a program. Therefore, Medicaid beneficiaries seeking to join a DPC practice would typically need to pay for the membership fees out-of-pocket.