Proposed Medicaid Pharmacy Legislation Could Help Bridge the State Budget Gap While Preserving Patient Access and Choice of Pharmacy

Representative Randy Fine, co-sponsor Rep. Jackie Toledo, and Senator Ana Maria Rodriguez recently announced the details of new proposed legislation that could save the State of Florida as much as $200 million per year while also expanding the Florida Medicaid pharmacy network and access to medication for the state’s anticipated 4.4 million Medicaid recipients.

HB 1043 and SB 1306 are bills that would “carve out” pharmacy coverage from the Statewide Medicaid Managed Care system. They call for the end of systemic overpayments to the pharmacy benefit manager (PBMs) middlemen currently overseeing Medicaid pharmacy, as uncovered in the state-funded Milliman Florida Medicaid report released last November. These overpayments — amounting to somewhere between $150 million and $200 million annually — are flowing out of Florida and away from the Medicare patients and providers for whom these monies are designated.

These health plans and their PBM middlemen partners would like everyone to believe PBMs are “misunderstood”, that the overpayments are not happening despite two independently-commissioned reports stating otherwise. In the absence of transparency, the health plans and PBMs can and do falsely claim they’re not billing as much as $200 million more than entitled. And because there’s currently no way for any state or federal agency to know for certain if the state is being bilked — not even the Agency for Healthcare Administration (AHCA), who administers Florida Medicaid — taxpayers have no choice but to keep paying.  Continue Reading

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