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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 …

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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 …

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What Every Challenger Brand Can Learn From The Nation’s Smallest Pharmacies

Forbes A campaign against drug rebate kickbacks isn’t something you’d typically think would have much relevance to small businesses in other industries.  However, a recent effort by a Florida-based small business pharmacy advocacy group, SPAR (Small Business Pharmacies Aligned for Reform), is offering a glimpse of how small, challenger businesses can fight back against much larger and more powerful organizations—and win. The founding of SPAR dates to a Trump administration Executive Order to prevent the drug rebate kickbacks passed between prescription drug manufacturers and pharmacy benefit managers (PBMs). Essentially, PBMs, which work with health insurance companies, negotiate with pharmaceutical companies to receive a portion of a drug’s list price every time that drug is dispensed. These “rebates,” which the PBMs receive, are factored into the cost of a drug’s final cost to the patient, which leads to steep price increases for consumers and patients. When PBMs and pharmaceutical companies launched heavily-funded lobbying …

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Study Finds PBMs are Draining Florida’s Medicaid Funds

Grit Daily A study exploring Florida’s prescription drug costs through the Medicaid program found that pharmacy benefit managers (PBMs) profited $89 million dollars, mostly from a spread pricing contract scheme that charges the state higher cost than will be disbursed to the pharmacist. Florida’s Medicaid program is contracted out to private healthcare companies like CVS Caremark, Humana, etc. Those private companies then take Medicaid dollars and draw up contracts with pharmacies around the state. PBMs play the role of negotiating drug prices between pharmacy suppliers and payers; they have an outsize stake in what consumers pay for their prescription drugs. PBMs in Florida operate in 2 ways depending on the county – pass-through or spread. Pass-through pricing reimburses pharmacists the cost of the drug, while PBMs take a small fee. Spread, on the other hand, reimburses a pharmacy a different amount for the drugs than what it charges the state. Grit Daily caught up …

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What “Big Insurance” Doesn’t Want You to Know About Community Pharmacies

Medium.com Patients and pharmacists share a special relationship, often stretching back generations. Even the frightening spike in drug costs can’t erode the feeling of trust and care we feel when walking into our neighborhood pharmacy. But “neighborhood pharmacies” as we know them are rapidly disappearing, victims of large corporate pharmacy benefit manager (PBM) “middlemen” that now dominate the drug industry. If you’ve never heard of PBMs, you’re not alone. The largest PBMs own or are owned by, well-known health insurers (UnitedHealth; CVS Health, CIGNA) — and all own or have affiliate relationships with their own pharmacies. If you’re a die-hard CVS or Walgreens shopper, you may not be familiar with the neighborhood (or community) pharmacy — but you should be. Community pharmacies are independently-owned pharmacies that provide the same services as national retail pharmacies but cost the same, if not less, than the “big” pharmacies. Think of independent pharmacies like …

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Why are neighborhood pharmacies disappearing? Ask the Noriega Family.

Lissette Campos – July 15, 2020 I arrived at Bill’s Prescription Center in Brandon an hour early, half expecting to find a quiet operation with the owner prepping for our television interview. After all, how busy can they be? I’m here because neighborhood pharmacies like this one, close to 100 in the Tampa Bay area alone, are in danger of closing. Common sense would have you believe the disappearing act is caused by a lack of customers. Three minutes in, I realized there’s nothing common sense about this situation. A steady stream of customers didn’t just walk in for their medicines, they arrived for, what felt like, a family reunion! “Hi Basil? How are you?” asked one woman, smiling under her face mask. “How’s your Dad?” asked a gentleman. “I love this place!” another customer whispered my way. “…been my pharmacy for years.” – the microphone in my hand inspiring …

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Neighborhood pharmacies struggle to stay open due to PBM restrictions

Tampa Bay News 10, July 9, 2020 So far, at least 8 independent Tampa Bay pharmacies have shut down because of challenges with Pharmacy Benefit Managers (PBM). As COVID-19 cases skyrocket in Florida, we’ve talked a lot about what doctors’ offices are doing, but what about pharmacies? Whether you realize it or not, your pharmacy options are becoming more limited but not because of COVID, but from something called Pharmacy Benefit Managers, or PBMs. It’s a big enough problem that one Tampa lawmaker is working to pass a bill to protect independent pharmacies and demand transparency. “Our motto here at Bill’s Prescription is to treat people like family,” pharmacist and owner of Bill’s Prescription John Basil Noriega said. Noriega’s family opened their own pharmacy back in 1956 in Brandon, at a time when the city population was just 2,000 people. “We have a lot of life long customers. We consider …

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Independent Pharmacists Stress Personal Touch In An Industry Dominated By Chains

The Town Crier, February 28, 2020 On Wednesday, Feb. 19, the advocacy group Small Business Pharmacies Aligned for Reform (SPAR) hosted a press conference at My Community Pharmacy in Wellington regarding pharmacy benefit managers (PBMs) and their effect on pharmaceutical pricing. Speakers at the event outlined what they called “shady” practices in the PBM industry that aims to put independent pharmacies, such as My Community Pharmacy, out of business. The pharmacy is located at 2615 S. State Road 7 near Whole Food Market in Wellington, owned by Johnny Meier, one of the speakers at the event. In attendance with Meier were other local, independent pharmacists, customers and Wellington Mayor Anne Gerwig. Several speakers addressed the problems involving pharmacy benefit managers — middlemen who are supposed to negotiate savings for customers — and complained that they do not, in practice, benefit either the pharmacists or their customers. The pharmacists addressed several bills …

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Opinion: Your local pharmacy is at risk of going away

83 Degrees, July 14, 2020 Tampa summers are typically the “slow season” for local pharmacies. But during COVID-19, nothing is typical nor should be taken for granted. The coronavirus pandemic coined the term “essential workers” and your local pharmacy is obviously essential, right? Pharmacies are always open, even in a public health crisis. Of course, they’re open, why wouldn’t they be open? Pharmacies are always there when people need them. But what happens if your local pharmacy can’t be there for you? Opinion column by Pharmacist Alex HerwigA recent survey among Florida independent pharmacies shed light on a little-known, but critical issue. Intended to examine the viability of Florida’s Medicaid managed care model on local pharmacies, the survey instead uncovered disturbing statistics: 61 percent of community pharmacies are being forced to reconsider participating in the Medicaid system. Another 41 percent are considering whether to close their business altogether. The problem …

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Okeechobee pharmacist demands ‘special session on drug pricing reform’

NBC WPTV 5, February 13, 2020 A popular pharmacist is calling for prescription drug pricing reform in Florida after a newly released report shows small pharmacies are having a difficult time competing with corporate giants and some in our region fear they will have to close their doors. For decades JoAnne White has chosen Okeechobee Discount Drugs for the savings and the people. “The prescriptions are just ridiculous,” said White. “If [this drugstore] goes out of business and I have to go to one of these others – I don’t know what I’ll have to do.” On Thursday, White and other customers stood in the drugstore – not for prescriptions – but to draw attention to the need for reform. “It is imperative that we demand a special session on drug pricing reform,” said Steven Nelson, a registered pharmacist, and Okeechobee Discount Drugs owner. “Lawmakers in Tallahassee continue to walk …

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