Dev

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 …

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

FL Pharmacy Groups Fight PBMs with HB 1043

Florida pharmacy advocacy group Small Business Pharmacies Aligned for Reform (SPAR) and national advocacy group Pharmacists United for Truth and Transparency (PUTT) counseled with Republican and Democrat state representatives to advocate for HB 1043’s passage. HB 1043, titled, “Medicaid Pharmacy Benefit Savings” would require: “AHCA to select single pharmacy benefit administrator through competitive procurement process by specified date; provides contract requirements; requires agency to calculate amount equal to specified percentage of managed care organization’s net underwriting gain for certain contract year & reduce organization’s contract term payment by such amount.” The sponsor of the bill, Rep. Randy Fine (D-53) claims that with this bill, “there will be losers”, however, “the taxpayer, the recipient, and the local pharmacy will benefit.  The people we are here to fight for will benefit.” Dawn Butterfield, the founding member of SPAR, claims that, “We as independent pharmacy owners have been ringing in our state’s Medicaid program for more than three …

FL Pharmacy Groups Fight PBMs with HB 1043 Read More »

Republicans look to curb prescription middlemen’s fees and practices

Florida Politics A recent report shows that Pharmacy Benefit Managers could be costing the state hundreds of millions. A band of Republican lawmakers hope to reel in pharmacy benefit managers and save Florida’s Medicaid program millions of dollars. They say their legislation (SB 1306/HB 1043) would level the playing field to contest unfair practices by pharmacy benefit managers, known as PBMs. In doing so, one sponsor, Doral Sen. Ana Maria Rodriguez, said the state could save at least $143 million in the bill’s first year. “Our pharmacies are being gouged for providing services to communities that would otherwise be left no choice and they’d suffer dire health consequences from lack of access to care,” said Rep. Jackie Toledo, a Tampa Representative who has routinely tackled issues tied to PBMs. Stuart Sen. Gayle Harrell, who has also championed health care reform, fears neighborhoods are losing their community pharmacies to PBMs, which …

Republicans look to curb prescription middlemen’s fees and practices Read More »

Bills seek to save Florida Medicaid hundreds of millions of dollars, improve prescription drug care for patients

The Capitolist Pharmacy advocacy groups gathered with Florida senators and representatives to discuss bills before the legislature designed to save the state millions of dollars and protect local pharmacies at a press conference today. Florida pharmacy advocacy group Small Business Pharmacies Aligned for Reform (SPAR) and national advocacy group Pharmacists United for Truth and Transparency (PUTT) were joined by Representative Randy Fine (R-District 53), Representative Jackie Toledo (R-Distirct 60), Senator Gayle Harrell (R-District 25), Senator Tom Wright (R-District 14), and Senator Ana Maria Rodriguez (R-District 39) at the State Capitol. HB 1043, sponsored by Fine and SB 1306, sponsored by Rodriguez, aim to move Florida Medicaid to a pharmacy fee-for-service model. If enacted, the move is projected to save the state almost $150 million in prescription drug costs while simultaneously increasing access for the state’s Medicaid recipients. Rodriquez said, “This is no small amount of money. That’s a lot of money, and a lot of taxpayer dollars these bills will …

Bills seek to save Florida Medicaid hundreds of millions of dollars, improve prescription drug care for patients Read More »

Marco Rubio Backs Jeanne Shaheen’s Proposal to Reduce Prescription Drug Prices

Florida Daily Last week, U.S. Sen. Marco Rubio, R-Fla., backed U.S. Sen. Jeanne Shaheen’s, D-NH, “Ensuring Timely Access to Generics Act.” The bill “would tackle exorbitant prescription costs by increasing competition for generic drugs through better oversight of the Food and Drug Administration’s (FDA) citizen petition process.” “This legislation ensures the FDA’s ability to reject citizen petitions if they believe that the primary purpose of the petition is to delay the approval of an application, thereby increasing competition in the marketplace and lowering costs for patients. The bill would also set a time limit to ensure that citizen petitions are submitted in a timely manner after the petitioning party becomes aware of the information upon which their petition is based. This time limit helps avoid instances where brand-name drug manufacturers slow down the FDA review process by filing citizen petitions shortly before a generic drug is set to be reviewed by FDA,” …

Marco Rubio Backs Jeanne Shaheen’s Proposal to Reduce Prescription Drug Prices Read More »

In letter to AHCA, EMPOWER Patients says PBM reform could save $100M

Florida Politics EMPOWER Patients sent a letter to new Agency for Health Care Administration Secretary Simone Marstiller on Friday apprising her of the taxpayer dollars going to pharmacy benefit managers, or PBMs. EMPOWER Patients is a coalition made up of neighborhood and independent pharmacists and pharmacies advocating for PBM reform. PBMs are middlemen between health care plans and pharmacies. They help determine which drugs will be covered by insurance plans and negotiate on behalf of insurers to secure discounts from drug manufacturers. When a claim is filed, PBMs collect money from those plans, then pass money to pharmacies via different methods. The letter comes after a recent hearing in the House Finance and Facilities Subcommittee where AHCA Deputy Secretary Beth Kidder and John Meerschaert, an actuary with Milliman, presented a report on the state’s pharmacy benefit manager (PBM) structure. The report estimated PBMs are pocketing $89.6 million through spread pricing, a system where PBMs don’t charge fees, but …

In letter to AHCA, EMPOWER Patients says PBM reform could save $100M Read More »

State Rep. Randy Fine Files House Bill To Lower Cost, Increase Access to Prescription Drugs

Space Coast Daily Florida State Rep. Randy Fine filed HB 1043 his week which would save the State of Florida more than $100 million in prescription drug costs while increasing access to critical prescription drugs to Medicaid recipients. “State studies conducted over the past year prove definitively that the only people in Florida benefiting from Prescription Benefits Managers are the Managers themselves,” said Fine. “By allowing PBMs to both serve as the middleman and the retailer we have destroyed the fiduciary duty to be efficient, and as a result, these companies are making hundreds of millions of dollars in government-mandated excess profits.” HB will shift to a fee-for-service model that more than a half dozen states have implemented, saving hundreds of millions of dollars. Fine said the number of pharmacies eligible to distribute these less-expensive drugs will increase dramatically, making it easier for these Floridians to obtain prescriptions from the …

State Rep. Randy Fine Files House Bill To Lower Cost, Increase Access to Prescription Drugs Read More »

Florida lawmakers to consider heatedly-opposed PBM reform again in 2021

The Center Square There is bipartisan support in the Florida Legislature to impose transparency requirements and restrict pharmacy benefit managers’ (PBMs) role in prescription drug costs. Nevertheless, bills seeking to do so have failed the last few years, including in 2020. A December audit commissioned by Florida’s Agency for Health Care Administration (AHCA) may spur that effort in 2021 after documenting “prescription markups” by PBMs cost Florida’s Medicaid system $113.3 million in 2020. According to the analysis by Millman, PBMs charged $89.6 million in “spread costs,” $17.9 million in administrative fees, $5.8 million in transaction fees and $47,000 in other fees during the 12-month examination of 22 million claims. Millman’s audit confirms PBMs have been “gaming the system,” Florida Pharmacy Association (FPA) CEO Michael Jackson said. “These middlemen siphon off cash to line their own pockets and control prescription drug decision-making in Florida.” FPA is a member of EMPOWER Patients, …

Florida lawmakers to consider heatedly-opposed PBM reform again in 2021 Read More »

Florida Lawmaker To Take Closer Look at Prescription Drug Costs

Bay News 9 When State Rep. Jackie Toledo (R-District 60) recently tried to fill a prescription for her daughter, she was surprised at how much the drug cost. “Originally, it was going to be $25,” Toledo said. “The pharmacy told me it was going to be $480.” Toledo says although she had a coupon that would have kept the cost at $25, the pharmacist initially refused to accept it. After a back and forth that lasted about 90 minutes, he went ahead and filled the prescription at the reduced price. “They said, ‘It’s because our PBMs would not take it,’ and that’s when I learned about the term PBMs,” she said. “PBMs” or prescription benefit managers, are a group of companies that work to lower prescription drugs costs by negotiating prices directly with drug makers. They often recommend health care plans use mail order drugs over traditional pharmacies which some …

Florida Lawmaker To Take Closer Look at Prescription Drug Costs Read More »

New insulin report highlights how incentives benefit middlemen, harm patients

The Pharma Letter The US Senate Finance Committee has released a new report detailing findings of its investigation into the role that market dynamics play in the pricing of insulins. The report conclusions further solidify what we already know: perverse incentives in the market drove up insulin costs for patients, according to a posting on the Pharmaceutical and Research Manufacturers of America website, by Brian Newell, deputy vice president of public affairs at PhRMA. Key Details Many insulins have experienced significant net price declines in recent years. Since 2014, the net prices for the most commonly used classes of insulins have declined by 40%-50%, on average. In fact, insulins are less expensive today than in 2007. Save As the Senate Finance Committee explains, “insulin manufacturers compete fiercely, using rebates as bargaining chips,” to secure favorable coverage on pharmacy benefit managers’ (PBMs) formularies. In fact, according to SSR Health, last year these dynamics lowered the …

New insulin report highlights how incentives benefit middlemen, harm patients Read More »

Scroll to Top