PBMs favor their own pharmacies in the Florida Medicaid program

STAT News Plus January 31, 2020 As angst rises over the prices paid for medicines, a new analysis finds some pharmacy benefit managers that contract with Medicaid managed care organizations in Florida are pushing prescriptions to drugstore chains they control, raising costs for consumers and taxpayers. The report, which analyzed approximately 350 million state Medicaid pharmacy claims from 2012 through 2019, noted that PBMs sometimes reimbursed their own pharmacies for certain medicines at substantially higher rates than what other drug stores received, and payments to their affiliated pharmacies greatly exceeded the cost to dispense the drugs. Continue Reading on STAT News

Pharmacists Say They Take Hit In Medicaid

Health News Florida January 31, 2020 Amid a legislative tussle with millions of dollars on the line, people who operate pharmacies in Florida contend they are getting short-changed by the state. A report released Thursday maintains that pharmacists participating in Florida’s Medicaid managed-care program are being woefully underpaid. State Medicaid officials estimate the cost of doing business in the Medicaid program is $10.24 per filled prescription. But on average, Medicaid managed-care plans paid pharmacists $2.72 per claim in 2018. The 202-page analysis was commissioned by the Florida Pharmacy Association and American Pharmacy Cooperative Inc. and was conducted by 3 Axis Advisors. It was based on a review of more than 350 million Medicaid managed-care claims between 2012 and 2019 and claims data from more than 100 small community pharmacies across Florida to help validate the state data. The claims showed researchers what each managed-care company reported paying for each drug …

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New study highlights predatory practices by pharmacy benefit managers that drive up costs for patients, taxpayers

Capitol Soup, January 30, 2020 Study analyzing 359 million prescription AHCA drug claims documents widespread abuse   Legislators and advocates for reducing costs and improving access to prescription drugs today hailed a new independent study documenting that Pharmacy Benefit Managers (PBMs) have pocketed millions of dollars from the Florida Medicaid system – funds that should have been directed toward health care for millions of low-income residents. The study, commissioned by the Florida Pharmacy Association and American Pharmacy Cooperative Inc. with data obtained from the Agency for Health Care Administration (AHCA) by the Small Business Pharmacies Aligned for Reform (SPAR), highlights the predatory nature of a handful of vertically integrated PBMs and managed care organizations (MCOs). Sen. Gayle Harrell and Rep. Jackie Toledo, who have each filed legislation to rein in predatory PBMs, underscored the need for greater transparency and oversight when it comes to PBMs’ role in Florida. Continue Reading on …

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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 …

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House and Senate in sync on PBM reform

Florida Politics, January 13, 2020 Will this be the year that Floridians at long last receive some financial relief from prescription drug costs? Physicians, pharmacists, and patients certainly hope so. One of the major issues heading into the 2020 Legislative Session is the role Pharmacy Benefit Managers (PBMs) play in setting prescription drug prices. PBM detractors often cast them as middlemen behind the rise of prescription prices. To that end, lawmakers have passed legislation eroding their profession in recent years. According to the Pharmaceutical Care Management Association (PCMA), a PBM trade association, their role is a little more nuanced. In their estimation, pharmacists deserve a share of the blame for rising prescription prices. At the core of the 2020 battle is a bill by Rep. Jackie Toledo and co-sponsor Rep. Randy Fine (HB 961) that would further limit PBMs’ ability to negotiate prices and rebates. The lawmakers held a news conference at a Tampa pharmacy last year pitching …

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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

Tom Wright bill pushes for pharmacy benefit manager reform

Florida Politics, December 24, 2019 State Sen. Tom Wright is pushing legislation for the upcoming 2020 Session that would increase regulation of pharmacy benefit managers (PBMs). A PBM is a company that helps determine which drugs will be covered by insurance plans. PBMs negotiate on behalf of insurers to secure discounts from drug manufacturers. But critics argue patients are being left behind when it comes to benefiting from any prospective savings. Wright’s bill (SB 1338) would up state-level regulation of those PBMs in several areas. First, it would increase the ability of the Office of Insurance Regulation (OIR) to examine the practices of those PBMs. Health insurers, health maintenance organizations and PBMs would be required to submit an annual report to the OIR by March 1 of each year. That report must include the numbers of prescriptions dispensed, the proportion of those prescriptions that were provided through retail pharmacies — as compared to …

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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 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 …

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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 again we see them deny, delay, or obstruct the treatment plans that have been carefully considered and approved by patients and their physicians,” said Dr. Brandon Konkel, an oncologist from Tampa …

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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 managers work with health plans and serve as sort of middlemen between drug manufacturers and pharmacies. Toledo’s bill, which is co-sponsored by Rep. Randy Fine, R-Palm Bay, would substantially amend the …

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