spread pricing

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 …

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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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The Secret Drug Pricing System Middlemen Use to Rake in Millions

Bloomberg September 11, 2018 For years, Frahm’s South Side Drug bought pills from distributors, and dispensed prescriptions to the Wapello County jail. In turn, the pharmacy got reimbursed for the drugs by CVS Health Corp., which managed the county’s drug benefits plan. As he compared the newspaper notice with his own records, and then with the county’s, Frahm saw that for a bottle of generic antipsychotic pills, CVS had billed Wapello County $198.22. But South Side Drug was reimbursed just $5.73. So why was CVS charging almost $200 for a bottle of pills that it told the pharmacy was worth less than $6? And what was the company doing with the other $192.49? Frahm had stumbled across what’s known as spread pricing, where companies like CVS mark up—sometimes dramatically—the difference between the amount they reimburse pharmacies for a drug and the amount they charge their clients. It’s where pharmacy benefit …

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