patient care

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 »

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 »

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 »

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 …

What “Big Insurance” Doesn’t Want You to Know About Community Pharmacies 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 have to do in order to receive it. This could be so much easier, if not for the intervention of middlemen known as pharmacy benefits managers, or PBMs. They have …

Brittany Jackson: Broken PBM system puts patient access at risk 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 to this interruption, my patient must now drive from Chattahoochee to my office three times a week for a more intensive IV treatment. Continue Reading on the Tallahassee Democrat

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 a specific standard medication approved by the Food and Drug Administration for this condition. However, when the prescription was submitted, the PBM – who is not a physician – denied …

How pharmacy benefit managers dictate care | Column Read More »

Scroll to Top