Preserve Patient Access to Neighborhood Pharmacies


Studies and Data

AHCA Commissioned Analysis of FL Medicaid Confirms Over $90Million in PBM Spread Pricing

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This recent independent analysis of Florida Medicare commissioned by the Agency for Health Care Administration (ACHA) sheds light on PBM fee and pricing practices in Florida's Statewide Medicaid Managed Care System (SMMC). The analysis confirms that PBMs have taken over $90 Million per year in excess profits through the use of spread pricing.

Legislative Leaders are Calling for Action

“Markets fail when markets get corrupted and that is what has happened here. When the middleman is allowed to own the end-retailer then the middlemen’s incentive to manage cost appropriately for the benefit of the chain is broken. And that is what has happened here.”

-- Rep. Randy Fine

“The power and control of PBMs has grown significantly over the last five to ten years. What we’re seeing is insurance companies owning PBMs and PBMs owning insurance companies. What is happening in the long run is that the price of prescriptions are going up.”

-- Sen. Gayle Harrell

“The practices PBMs use to drive up profits are complex, but the solution is simple: We need to increase access to care for all Floridians while ensuring that prescription drug savings make it to the patient and not the pockets of predatory PBMs.”

-- Rep. Jackie Toledo

When it comes to PBMs,
we all pay the price.

Pharmacy Benefit Managers (PBMs) are middlemen who have strayed from their original purpose of negotiating savings for patients and now keep the profits for themselves, leaving the rest of Florida’s consumers to pay higher drug prices. PBMs use anti-competitive practices to short-circuit the free market and create health care monopolies.

These predatory tactics decrease access for patients, force neighborhood pharmacies to close down, and raise costs for everyone. We need legislation that will increase transparency and accountability on PBMs and ensure that patients are prioritized over profits.

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Who do PBM predatory tactics hurt?

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Patients

Forcing neighborhood pharmacies out of PBM health networks causes many patients to drive extra miles from their home to receive medications simply because their local pharmacy is not in their plan. This not only steers business away from neighborhood pharmacies, it severely restricts patients’ access to medications and drives up their costs.

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Pharmacists

Many neighborhood pharmacies diligently refill prescriptions only to be hit with reimbursements that are pennies on the dollar – with some even facing negative reimbursements or clawbacks – while PBMs continue to make record-breaking profits. No business can sustain operations under this model, and it is a clear manipulation of the system that promotes anti-competitive practices.

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Providers

PBMs are overstepping their scope and making medical decisions best left to physicians and pharmacists – and their years of training. PBMs are motivated by profit, not by what is best for the patient, and many times PBMs require the use of drugs or specialty medications that are not the most beneficial for the patient.

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Payors

The anti-competitive policies that PBMs push increase health care costs for everyone. PBMs don’t make or provide the drug – they don’t even touch the drug – yet they add costs to the overall health care system that must be absorbed by pharmacists, patients, and all Floridians.

How Can We Fix This?

This year, the Florida Legislature is considering legislation to address these challenges. SB 1444 and HB 961 implement transparency, accountability, and free-market policies that will help preserve patient access and keep drug prices affordable.

Here are some highlights of the legislation:

  • Protect the free market by prohibiting anti-competitive policies that reduce patient choice and create health care monopolies
  • Eliminate the practice of steering patients to PBM-owned pharmacies, especially when it involves taxpayer dollars
  • Prohibit the predatory practices that PBMs use to squeeze independent pharmacies, including post-adjudication fees, spread pricing, and cumbersome audit practices

By supporting this legislation, we can bring about concrete change in the industry and put a stop to the abuses that leave Floridians suffering.

News

Florida Pharmacists Sounding the Alarm, Accuse PBMs of ‘Hijacking’ Health Care Spending

Florida Daily October 30, 2019 With Americans continuing to be impacted by the spiraling costs of health care, some neighborhood pharmacists across Florida have an idea to do something about the growing problem. Pharmacists across Florida have banded together to push for reforms to add more transparency to Pharmacy Benefit Managers (PBMs) which, the pharmacists insist, are driving up costs. PBMs originally came into existence to be a helpful “middle man” between pharmaceutical companies, insurers and local pharmacies. They were initially designed to control costs and negotiate savings which would allow pharmacists to spend more time advising customers, making deliveries when needed and working out payment arrangements […]

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Trump wants lower prescription drug costs. Florida lawmakers should make the market more competitive

The Capitolist October 9, 2019 President Donald Trump visited Florida last week, making a stop at The Villages, one of the highest concentrations of American citizens who depend heavily on prescription medications. During the stop, he highlighted one of his highest priorities: making prescription drugs affordable for all Americans. One of the fastest ways to make that happen requires bold action in Tallahassee, and it’s needed sooner rather than later, because independent pharmacies are closing all across the state of Florida, giving rise to large chains that dominate the market, restrict consumer choice, and remove competition from the price equation. Worse, current public policy is slowly, […]

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Forget Canada, Florida has a home-grown fix for Rx prices

Florida Politics March 5, 2019 Gov. Ron DeSantis recently pitched the idea of importing prescription drugs from Canada to help out Floridians getting raked over the coals during their monthly trip to the pharmacy. It sounds like a fine plan on its face, but there’s a loaf of logistics that need to be ironed out before Canuck capsule can be doled out to Florida patients. That’s not to say it couldn’t happen — the Department of Health and Human Services (HHS) has had the authority to allow importation from Canada for more than a decade — but it would take policy changes at the federal level in order to […]

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Watchdog: Insurance Groups Buy Drug “Middle Men”; Transparency Calls Grow

Spectrum News 13 July 23, 2019 PBMs: have you heard of them? If not, you’re not alone, but they do factor into your prescription drug costs. They’re essentially a “middle man” between drug makers, health care plans, and patients, negotiating the prices most of us pay for prescription drugs. n the last two years, health insurance companies, which set deductibles and co-pays, have bought up the three main PBMs: Express Scripts, CVS Caremark, and Optum RX. A number of independent pharmacies have told Spectrum News they are now losing business and revenue because of PBMs, including Five Points Pharmacy in Cocoa, a pharmacy that has been welcoming […]

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Independent pharmacies being driven out of business by ‘predatory middlemen’ | Opinion

South Florida Sun Sentinel October 21, 2019 Lately, everywhere you look there are people worried about keeping drug prices affordable, especially for Florida’s aging seniors. People are voicing their concerns, but many are ignoring one of the biggest factors contributing to reduced access and increased costs — and sometimes driving people like me out of business. Pharmacy Benefit Managers, or PBMs, have been abusing their power for years, remaining undetected as they drive independent pharmacies into the ground. These predatory middlemen no longer serve their original purpose of negotiating medication savings for patients. Instead, they use their corporate clout to force patients to certain pharmacy […]

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Jackie Toledo plans to tackle prescription drug prices by regulating the middleman

Florida Politics December 9, 2019 Rep. Jackie Toledo plans to file legislation this week that would lower prescription drug prices for some consumers and protect small pharmacy owners by regulating what are known as pharmacy benefit managers. Pharmacy benefit managers, or PBMs, serve as middlemen between pharmacies and health insurance companies to provide real-time benefit analysis and actual costs for consumers purchasing prescription medication. These individuals are meant to make it easier for pharmacies to obtain health insurance benefit information on patients so they can get their prescriptions in a timely fashion, but their presence has morphed into what some believe is a profit-driven model that favors insurance […]

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