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FL Pharmacy Groups Fight PBMs with HB 1043

Florida pharmacy advocacy group Small Business Pharmacies Aligned for Reform (SPAR) and national advocacy group Pharmacists United for Truth and Transparency (PUTT) counseled with Republican and Democrat state representatives to advocate for HB 1043’s passage. HB 1043, titled, “Medicaid Pharmacy Benefit Savings” would require: “AHCA to select single pharmacy benefit administrator through competitive procurement process by specified date; provides contract requirements; requires agency to calculate amount equal to specified percentage of managed care organization’s net underwriting gain for certain contract year & reduce organization’s contract term payment by such amount.” The sponsor of the bill, Rep. Randy Fine (D-53) claims that with this bill, “there will be losers”, however, “the taxpayer, the recipient, and the local pharmacy will benefit.  The people we are here to fight for will benefit.” Dawn Butterfield, the founding member of SPAR, claims that, “We as independent pharmacy owners have been ringing in our state’s Medicaid program for more than three …

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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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Florida lawmakers to consider heatedly-opposed PBM reform again in 2021

The Center Square There is bipartisan support in the Florida Legislature to impose transparency requirements and restrict pharmacy benefit managers’ (PBMs) role in prescription drug costs. Nevertheless, bills seeking to do so have failed the last few years, including in 2020. A December audit commissioned by Florida’s Agency for Health Care Administration (AHCA) may spur that effort in 2021 after documenting “prescription markups” by PBMs cost Florida’s Medicaid system $113.3 million in 2020. According to the analysis by Millman, PBMs charged $89.6 million in “spread costs,” $17.9 million in administrative fees, $5.8 million in transaction fees and $47,000 in other fees during the 12-month examination of 22 million claims. Millman’s audit confirms PBMs have been “gaming the system,” Florida Pharmacy Association (FPA) CEO Michael Jackson said. “These middlemen siphon off cash to line their own pockets and control prescription drug decision-making in Florida.” FPA is a member of EMPOWER Patients, …

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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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Prescription for Transparency

California Business Journal – August 25, 2020 Pharmacy Benefit Managers (PBMs) were created to be the middleman and negotiate drug prices. Working with the health care providers, pharmacies and the pharmaceutical companies determine reimbursements and what they’d charge the pharmacies. The problem is that without regulation, the PBMs have bad business practices. The fix is on the way. Magnified by the economic and health care impacts of the novel coronavirus, the Florida legislature is honing in on regulations for a long-veiled middleman in the chain of rising prescription drug pricing. Intended to serve as a beneficial consumer go-between for pharmacies and health insurance companies to provide cost analysis, Pharmacy Benefit Managers (PBMs) have instead transformed into a profit-driven model favoring, among other things, large pharmacy chains over payer and patient pocketbooks. The classic Big Guy vs. Little Guy yarn was threatening to spin out-of-cost-control until organized advocacy groups and legislative …

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Pharmacy Deserts Are on the Horizon if PBMs Continue to Underpay Medicaid Reimbursements

Grit Daily – August 17, 2020 Independent pharmacies are being forced into bankruptcy due to underpayment for Medicaid reimbursements, which are managed by Pharmacy Benefit Managers (PBMs.) These small pharmacies are deciding to either turn away Medicaid patients or to close their practices, creating pharmacy deserts in poor neighborhoods. A survey of 123 independent pharmacies in Florida found that over 60% “may be forced to discontinue taking Medicaid patients if changes are not made to the program that currently requires neighborhood pharmacies to sell most prescription drugs at a loss.” 93% declared having to turn away at least one Medicaid patient per month because dispensing to them would cause the pharmacy to lose money. There are ripple effects to having pharmacies take repeated financial losses in order to provide patients with necessary medications. Many of the customers who were refused Medicaid drug fulfillment ended up having an adverse health effect. This puts a …

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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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Pharmacy Benefit Managers Are the Real Reason Behind Skyrocketing Drug Prices

Grit Daily – April 30, 2020 Why are drug costs so high in America? If you ask Bernie Sanders, he will tell you that it’s due to the greed of the pharmaceutical industry. If you remember when “pharma bro” Martin Shkreli, former CEO of Turing Pharmaceuticals, made the price of the life saving drug Daraprim 5,000% higher overnight, you may agree with this assessment. But, there is more to the story, and it has to do with Pharmacy Benefit Managers (PBM’s). Within the healthcare industry, there are pharmaceutical manufacturers, pharmacists, insurance companies, and Managed Care Organizations (MCO) for Medicaid, but there is one more player that few outside of the industry discuss—the pharmacy benefit manager, or PBM. A PBM’s original role was to negotiate lower drug costs between drug manufacturers and insurance companies, with the goal of passing those savings on to the consumer. Instead, the rise of PBMs, who have amassed great …

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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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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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