Latest News

Alex Andrade tackles Rx drug legislation, but does it go far enough?

The Floridian, February 21, 2020 Florida state Rep. Alex Andrade (R) is advocating for a bill that would create more transparency around the prescription drugs that Floridians buy. But some groups are questioning whether it goes far enough. This week, Rep. Andrade presented his bill about prescription drugs to the House Health and Human Services Committee. The bill, HB 7045, addresses a number of different aspects including creating advanced notice requirements for drug price increases and requiring new reporting standards for certain entities in the prescription drug market. However, critics point out that the bill does not fix one issue that many consider is the biggest issue facing prescription drug supply chains, which is pharmacy benefit managers or PBMs. In a recent […]

Read More

Local pharmacists complain drug middlemen hurt patient prices and business

Citrus County Chronicle February 12, 2020 In the competitive pharmaceutical industry where drug manufacturers vie for huge market shares, middlemen work billion dollar deals, and pharmacy goliaths dominate the prescription landscape, it’s hard to be small, and, in many cases, unfair. That’s the take by Jesse Brashear, of Brashear’s Pharmacy in Lecanto and Inverness, and who is hoping proposed legislation that requires more transparency about drug prices. Brashear’s focus during a local press conference Wednesday was predominately on pharmacy benefit managers and House Bill 961. Brashear said pharmacy benefit manager middlemen who work out drug prices between pharmacies and insurance payers often favor large chain pharmacies or pharmacies they own, leaving small, local pharmacies to wither pacing far lower reimbursement […]

Read More

Study finds millions in Medicaid unfairly pocketed by Pharmacy Benefit Managers

The Capitolist February 4, 2020 A new Florida study, released last week, found that major health care companies using pharmacy benefit managers (PBM’s) have positioned themselves to pocket millions of dollars from the state’s Medicaid system that were intended to lower costs for millions of low-income Floridians. The study found that despite processing less than half of one percent of all pharmacy claims, specialty pharmacies affiliated with PBM’s managed to collect 28 percent of the available profit margin from dispensing prescription drugs. The study was commissioned by the Florida Pharmacy Association and American Pharmacy Cooperative Inc. using data obtained from Florida’s Agency for Health Care Administration (AHCA) by the Small Business Pharmacies Aligned for Reform.  Smaller pharmacy operators say the report […]

Read More

PBMs favor their own pharmacies in the Florida Medicaid program

STAT News Plus January 31, 2020 As angst rises over the prices paid for medicines, a new analysis finds some pharmacy benefit managers that contract with Medicaid managed care organizations in Florida are pushing prescriptions to drugstore chains they control, raising costs for consumers and taxpayers. The report, which analyzed approximately 350 million state Medicaid pharmacy claims from 2012 through 2019, noted that PBMs sometimes reimbursed their own pharmacies for certain medicines at substantially higher rates than what other drug stores received, and payments to their affiliated pharmacies greatly exceeded the cost to dispense the drugs. Continue Reading on STAT News

Read More

Pharmacists Say They Take Hit In Medicaid

Health News Florida January 31, 2020 Amid a legislative tussle with millions of dollars on the line, people who operate pharmacies in Florida contend they are getting short-changed by the state. A report released Thursday maintains that pharmacists participating in Florida’s Medicaid managed-care program are being woefully underpaid. State Medicaid officials estimate the cost of doing business in the Medicaid program is $10.24 per filled prescription. But on average, Medicaid managed-care plans paid pharmacists $2.72 per claim in 2018. The 202-page analysis was commissioned by the Florida Pharmacy Association and American Pharmacy Cooperative Inc. and was conducted by 3 Axis Advisors. It was based on a review of more than 350 million Medicaid managed-care claims between 2012 and 2019 and […]

Read More

New study highlights predatory practices by pharmacy benefit managers that drive up costs for patients, taxpayers

Capitol Soup, January 30, 2020 Study analyzing 359 million prescription AHCA drug claims documents widespread abuse   Legislators and advocates for reducing costs and improving access to prescription drugs today hailed a new independent study documenting that Pharmacy Benefit Managers (PBMs) have pocketed millions of dollars from the Florida Medicaid system – funds that should have been directed toward health care for millions of low-income residents. The study, commissioned by the Florida Pharmacy Association and American Pharmacy Cooperative Inc. with data obtained from the Agency for Health Care Administration (AHCA) by the Small Business Pharmacies Aligned for Reform (SPAR), highlights the predatory nature of a handful of vertically integrated PBMs and managed care organizations (MCOs). Sen. Gayle Harrell and Rep. Jackie […]

Read More

Brittany Jackson: Broken PBM system puts patient access at risk

Florida Politics,  January 16, 2020 Four years after I was diagnosed with heart failure in 2013, I had a heart attack. My heart was failing, and my only option was a heart transplant. I was fortunate when a donor heart became available, and I have lived with my new heart since July 2018. Having a healthy organ is a true gift, and I view it as such. I am diligent about doing whatever I need to in order to take care of this gift that saved my life, including spending the rest of my life taking transplant medications so my body doesn’t reject this gift. I am certainly grateful that this medication exists, but I’m not happy about what I […]

Read More

House and Senate in sync on PBM reform

Florida Politics, January 13, 2020 Will this be the year that Floridians at long last receive some financial relief from prescription drug costs? Physicians, pharmacists, and patients certainly hope so. One of the major issues heading into the 2020 Legislative Session is the role Pharmacy Benefit Managers (PBMs) play in setting prescription drug prices. PBM detractors often cast them as middlemen behind the rise of prescription prices. To that end, lawmakers have passed legislation eroding their profession in recent years. According to the Pharmaceutical Care Management Association (PCMA), a PBM trade association, their role is a little more nuanced. In their estimation, pharmacists deserve a share of the blame for rising prescription prices. At the core of the 2020 battle is a […]

Read More

Pharmacy benefit managers are making decisions that harm my Tallahassee patients | Opinion

Tallahassee Democrat, January 11, 2020 There are people with no medical training and no obligation to patients who have the power to override medical decisions made by patients and their physicians. These people are pharmacy benefit managers — called PBMs. These pharmaceutical middlemen claim their role is to negotiate savings on prescriptions for patients. But their scope extends dangerously beyond business negotiations. They can decide whether patients can receive the treatments recommended by their physicians. These are businessmen, not medical professionals — and they are altering the care patients receive. Many of my patients in Tallahassee have had their health jeopardized by these dangerous practices. Delays from PBMs recently left one of my patients without oral chemotherapy medication for six weeks. Those delays have real consequences and, due […]

Read More

Tom Wright bill pushes for pharmacy benefit manager reform

Florida Politics, December 24, 2019 State Sen. Tom Wright is pushing legislation for the upcoming 2020 Session that would increase regulation of pharmacy benefit managers (PBMs). A PBM is a company that helps determine which drugs will be covered by insurance plans. PBMs negotiate on behalf of insurers to secure discounts from drug manufacturers. But critics argue patients are being left behind when it comes to benefiting from any prospective savings. Wright’s bill (SB 1338) would up state-level regulation of those PBMs in several areas. First, it would increase the ability of the Office of Insurance Regulation (OIR) to examine the practices of those PBMs. Health insurers, health maintenance organizations and PBMs would be required to submit an annual report to the OIR […]

Read More
Scroll to Top