Florida
Multiple DPC practices are located in Florida. In 2018 Florida became the 24th state to pass DPC "not insurance" legislation when Governor Scott signed SB 80 and HB 37 on March 23, 2018. Make sure to review Title 37 Insurance Chapter 624 when drafting your DPC contracts. If you are looking for a Non-compete resource this Nova Law Review article from 2010 by John Sanchez entitled A Survey of Physician Non-Compete Agreements in Employment Under Florida Law is a great start along with FLA. STAT. § 542.335(1)(d)(1).
Physician Dispensing is permitted in Florida. If you would like to dispense medications you should register as a "dispensing practitioner" with the Florida Board of Medicine. They do have a formalized process where the physician must complete the simple three page dispensing form listed at the top of this page and pay a $100 fee. Their detailed description of their dispensing rules can be found on this page. Here is the most important language:
64B8-4.029 Registration as a Dispensing Physician; Delegation of Dispensing to Prescribing Physician Assistants.
A physician may dispense drugs to his or her patient in the regular course of his or her practice provided that the physician is registered as a dispensing physician with the Board of Medicine. In order to register as a dispensing physician, the physician must:
(1) Submit application to the Board on form DH-MQA 1070, entitled “Physician Dispensing Registration,” (7/11), which is hereby incorporated by reference and available from http://www.flrules.org/Gateway/reference.asp?No=Ref-00780, or the Board of Medicine’s website at http://www.doh.state.fl.us/mqa/medical/me_applicant.html;
(2) Comply with the provisions of Section 465.0276, F.S., regarding dispensing physicians; and,
(3) Pay the registration fee as set forth in Rule 64B8-3.006, F.A.C.
(4) Pursuant to Section 458.347(4)(e), F.S., a dispensing physician who supervises a Florida-licensed prescribing physician assistant has the authority to delegate to the prescribing physician assistant the dispensing of any medication used in the supervising physician’s practice unless such medication is listed in the formulary set forth in Rule 64B8-30.008, F.A.C. The delegation of dispensing to the prescribing physician assistant must be documented with the Board of Medicine by completing form DH-MQA 1240, entitled “Dispensing Physician Assistant,” (8/10), which is hereby incorporated by reference and available from the Board of Medicine’s website at http://www.doh.state.fl.us/mqa/medical/me_applicant.html. No fee is required for the delegation of dispensing to physician assistants.
Patient Brokering Act (recently modified in 2019):
It is unlawful for any person, including any health care provider or health care facility, to:
(a) Offer or pay a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, to induce the referral of a patient or patronage to or from a health care provider or health care facility;
(b) Solicit or receive a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, in return for referring a patient or patronage to or from a health care provider or health care facility;(c) Solicit or receive a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, in return for the acceptance or acknowledgment of treatment from a health care provider or health care facility; or…
(3) This section shall not apply to:
(a) Any discount, payment, waiver of payment, or payment practice not prohibited by 42 U.S.C. s. 1320a-7b(b) or regulations promulgated thereunder.
(b) Any payment, compensation, or financial arrangement within a group practice as defined in s. 456.053, provided such payment, compensation, or arrangement is not to or from persons who are not members of the group practice.
(c) Payments to a health care provider or health care facility for professional consultation services.
(d) Commissions, fees, or other remuneration lawfully paid to insurance agents as provided under the insurance code…
“Insurance” is a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies.
Notably - some prepaid service plans have been explicitly excluded from the definition of insurance.
A political subdivision of this state which, on October 1, 1991, was operating an emergency medical services system established by special act and offers a prepaid ambulance service plan as part of its emergency medical services system shall, with respect to the prepaid ambulance services plan, be exempt from the provisions of the Florida Insurance Code.
Chapter 641 Part 1 Health Maintenance Organizations
641.19 Definitions.
(12) “Health maintenance organization” means any organization authorized under this part which:
(a) Provides, through arrangements with other persons, emergency care, inpatient hospital services, physician care including care provided by physicians licensed under chapters 458, 459, 460, and 461, ambulatory diagnostic treatment, and preventive health care services.
(b) Provides, either directly or through arrangements with other persons, health care services to persons enrolled with such organization, on a prepaid per capita or prepaid aggregate fixed-sum basis.
(c) Provides, either directly or through arrangements with other persons, comprehensive health care services which subscribers are entitled to receive pursuant to a contract.
(d) Provides physician services, by physicians licensed under chapters 458, 459, 460, and 461, directly through physicians who are either employees or partners of such organization or under arrangements with a physician or any group of physicians..."
It took many years of repeated efforts to get DPC "not insurance" legislation passed in Florida. This is a brief history: PCB HIS 15-02 passed out of its House subcommittee (check out the recorded discussions of the legislation), but ultimately failed to receive passage out of the full house due to unfortunate timing. The same DPC bill was one of the few to be revived in the June 2015 special session, and is was passed out of the House as HB 25A but was never voted on in the Senate. Renewed efforts in 2017 with the introduction of SB 240 and HB 161 ultimately failed as well when the popular bipartisan DPC language was mysteriously bundled with other less popular bills.