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How pharmacy benefit managers dictate care | Column

Tampa Bay Times by: Dr. Michael Diaz December 26, 2019 When patients are battling a life-threatening disease like cancer, they want a skilled and qualified physician advising them about treatment plans and the best way to beat this insidious disease. But that’s not always what they get. Sometimes, predatory middlemen called pharmacy benefit managers insert themselves into the decision-making process between the doctor and patient. As just one example, our team was working with a patient who had metastatic kidney cancer. Both the medical oncologist and urologic surgeon determined that the patient was not a candidate for surgery because of the patient’s other health conditions and the extremely low probability of a cure or any benefit. His doctors instead recommended […]

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Florida lawmakers push to improve access to prescription drugs, lower costs

The Capitolist December 20, 2019 Calling out Pharmacy Benefit Managers, or “PBM’s” for predatory business practices, a bipartisan group of lawmakers that includes Republicans Jackie Toledo and Randy Fine, Democrat State Rep. Kamia Brown and Democrat State Senator Jose Javier Rodriguez, unveiled new legislation this week designed to increase Floridian’s access to prescription drugs while lowering costs. The proposal would limit the practice of forcing patients to get their prescription drugs from pharmacies owned by pharmacy benefit managers. At a news conference announcing the plan, the lawmakers were joined by patients, doctors and pharmacists and small business owners who say PBM’s are pocketing most of the alleged savings they are able to procure. “PBMs aren’t medical doctors, and they shouldn’t be making medical decisions. Yet time and […]

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Proposed Florida legislation targets pharmacy benefit managers

Tampa Bay Business Journal December 18, 2019 In an attempt to lower health care costs for Floridians, a Tampa Republican and other lawmakers want to crack down on the role of pharmacy benefit managers. Rep. Jackie Toledo held a news conference Tuesday to announce a proposal (HB 961) that would create a new law called the “Prescription Drug Cost Reduction Act” and make clear that certain practices, such as directing patients to pharmacies owned in whole or in part by pharmacy benefit managers should be prohibited. The 53-page bill was lauded by the Florida Pharmacy Association, which maintains that so-called PBMs are driving independent pharmacies out of business. But it was criticized by the managed care industry, which calls it a “misdirected attack.” Pharmacy benefit […]

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Florida Lawmaker Fights to Improve Access to Prescription Drugs, Lower Costs

Florida Daily December 19, 2019 Florida state Rep. Jackie Toledo, R-Tampa, was joined by fellow lawmakers, patients, physicians, pharmacists, and small business owners this week to announce legislation that she says would increase Floridians’ access to prescription drugs while lowering costs. Supporters of the legislation say new legislation is needed to directly address what has been called “predatory practices” by Pharmacy Benefit Managers (PBMs). “Our priority is advocating for Floridians who have felt the pinch in their wallets because profit-driven policies by PBMs are robbing patients of savings that should rightly be theirs,” said Toledo. “Consumers need to know that their state lawmakers are fighting for their best interests, and our legislation will help put the power back where it belongs: with […]

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Jackie Toledo officially files Pharmacy Benefit Manager reform bill

Florida Politics December 19, 2019 Rep. Jackie Toledo filed legislation Tuesday to crack down on what she describes as over-charges on prescription medication caused by predatory practices among Pharmacy Benefit Managers, or PBMs.” Those are pharmacy middlemen established to facilitate claims approval for medications that require authorization in real-time. The bill (HB 961) addresses the pricing disparity between how much PBMs charge insurance providers compared to how much they reimburse pharmacies, paying self-owned pharmacies more than other pharmacies or steering patients to pharmacies they own and PBMs not passing along savings from third-party rebates. The bill would also increase transparency by requiring all information, including PBM revenue, to be reported to the state. PBMs in violation of the proposed law would be subject to $10,000 […]

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Tampa Lawmaker Files Legislation To Reform Prescription Drug Industry In Florida

Health News Florida December 18, 2019 A Tampa lawmaker is hoping to lower drug prices and improve care for Floridians by regulating companies that serve as middlemen in the health care industry. Rep. Jackie Toledo, R-Tampa, filed legislation on Tuesday that would rein in the industry that helps decide how consumers get their pharmaceuticals and how much they will pay for them. Pharmacy Benefit Managers, or PBMs, such as CVS Caremark, Optum RX and Express Scripts control roughly 80 percent of the market in Florida and around the country. That means they have a large say in which medications make it on a list of drugs that are covered by insurance companies. “This comprehensive piece of legislation will create transparency […]

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Bay Area Lawmaker Takes On Pharmacy Benefit Managers

Bay News 9 December 17, 2019 State Rep. Jackie Toledo officially announced a new bill Tuesday that she said is designed to lower prescription drug costs while increasing pharmacy access to all patients. State Rep. Toledo outlines Prescription Drug Cost Reduction Act HB 961 is gaining bipartisan support Toledo says pharmacy benefit managers are price gouging Surrounded by pharmacy owners, patients, other state representatives, and even doctors, she outlined the Prescription Drug Cost Reduction Act. “The PBMs would have to disclose how they are making their money, and it would prohibit the practice of spread pricing, which is charging someone more than what the drug actually costs, or reimbursing the pharmacies less than what the drug costs,” said Toledo, a Republican. “Plus, […]

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Tampa lawmaker Jackie Toledo leads push to lower drug costs in Florida

Tampa Bay Times December 17, 2019 Jackie Toledo recently had an issue with the cost of medication. It’s a problem the Republican state representative from South Tampa said she’s heard too many times before. Toledo said this kind of scenario is happening way too often. That’s why she’s filing a bill today to regulate pharmacy benefit managers, or PBMs. The measure, she said, would keep drug costs down for consumers and independent pharmacies in Florida. Called the Prescription Drug Cost Reduction Act, the bill aims to prohibit health care monopolies that reduce patient choice, and to eliminate the practice of “steering” patients to PBM-owned pharmacies. It also would prohibit predatory practices that threaten to squeeze independent pharmacies. “Florida should have […]

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Florida lawmaker’s bill to reduce prescription costs gains national support

Fox 13 News December 17, 2019 A Florida lawmaker is pushing to make your next trip to the pharmacy easier and less expensive under a proposed bill to cut price gouging for drugs and give you more choice on where to get prescriptions filled. Loretta Boesing will never forget the day something went wrong with her son’s medication. “My son, Wesley had a liver transplant at the age of 2. And after they shipped his medications in only a bag on a 102-degree day, he ended up going into liver transplant rejection,” said Boesing. The medicine was not at the right temperature, which could destroy its effectiveness, she said. Eight years later, Boesing’s family is still forced to use mail-order […]

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Rep. Toledo files bill to address sky-high prescription drug prices

The Floridian December 18, 2019 Cutting the astronomical costs of prescription drugs is a bipartisan effort that is being pushed both at the federal and state levels of government, and considering that Florida has a huge and growing retirement community, the need to cut drug costs for those on a fixed retirement income is that much more important. Sen. Rick Scott (R) and Rep. Debbie Mucarsel-Powell (D) have both vowed to address the costly drug problem, penning their own federal legislation to help curb the issue. Accessibility to less –expensive drugs is also part of the mix, so it’s not a surprise that state legislators like Rep. Jackie Toledo (R) and others are banning together with healthcare providers to announce legislation (HB 961) that would address […]

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