transparency

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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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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Marco Rubio Backs Jeanne Shaheen’s Proposal to Reduce Prescription Drug Prices

Florida Daily Last week, U.S. Sen. Marco Rubio, R-Fla., backed U.S. Sen. Jeanne Shaheen’s, D-NH, “Ensuring Timely Access to Generics Act.” The bill “would tackle exorbitant prescription costs by increasing competition for generic drugs through better oversight of the Food and Drug Administration’s (FDA) citizen petition process.” “This legislation ensures the FDA’s ability to reject citizen petitions if they believe that the primary purpose of the petition is to delay the approval of an application, thereby increasing competition in the marketplace and lowering costs for patients. The bill would also set a time limit to ensure that citizen petitions are submitted in a timely manner after the petitioning party becomes aware of the information upon which their petition is based. This time limit helps avoid instances where brand-name drug manufacturers slow down the FDA review process by filing citizen petitions shortly before a generic drug is set to be reviewed by FDA,” …

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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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Study finds millions in Medicaid unfairly pocketed by Pharmacy Benefit Managers

The Capitolist February 4, 2020 A new Florida study, released last week, found that major health care companies using pharmacy benefit managers (PBM’s) have positioned themselves to pocket millions of dollars from the state’s Medicaid system that were intended to lower costs for millions of low-income Floridians. The study found that despite processing less than half of one percent of all pharmacy claims, specialty pharmacies affiliated with PBM’s managed to collect 28 percent of the available profit margin from dispensing prescription drugs. The study was commissioned by the Florida Pharmacy Association and American Pharmacy Cooperative Inc. using data obtained from Florida’s Agency for Health Care Administration (AHCA) by the Small Business Pharmacies Aligned for Reform. Smaller pharmacy operators say the report proves that larger, vertically integrated companies that use PBM’s are using “predatory” business practices that short-circuit the free market. State lawmakers expressed alarm at the news and underscored the need …

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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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Tampa Lawmaker Files Legislation To Reform Prescription Drug Industry In Florida

Health News Florida December 18, 2019 A Tampa lawmaker is hoping to lower drug prices and improve care for Floridians by regulating companies that serve as middlemen in the health care industry. Rep. Jackie Toledo, R-Tampa, filed legislation on Tuesday that would rein in the industry that helps decide how consumers get their pharmaceuticals and how much they will pay for them. Pharmacy Benefit Managers, or PBMs, such as CVS Caremark, Optum RX and Express Scripts control roughly 80 percent of the market in Florida and around the country. That means they have a large say in which medications make it on a list of drugs that are covered by insurance companies. “This comprehensive piece of legislation will create transparency from prescription drug pricing and positively affect patients’ wallets at the pharmacy,” Toledo said during a press conference in Tampa to announce the bill. Continue Reading

Florida’s Rx drug supply chain needs fixing, more transparency

The Floridian November 6, 2019 Yesterday, the Florida Senate met in two separate committees to discuss the issue of Pharmacy Benefit Managers (PBMs) in the prescription drug supply chain. Both meetings had diverse panels representing the various interests in the matter as they attempted to move toward reform. The Senate Committee on Health Policy met in the morning with four panelists from the Small Business Pharmacies Aligned for Reform (SPAR), Coalition of State Rheumatology Organizations, Pharmaceutical Care Management Association, and Florida Association of Health Plans Inc. They discussed issues including transparency, contracting, payments, steering, and clawbacks. Independent pharmacist, Kevin Duane, stated that the inefficiencies of the PBM process have an eventual effect on the health of the patient. Over the past four years, 15% of the independent pharmacies in Florida have shut down, and there’s been an alarming drop in medication adherence. He cited that “the patients, when an independent pharmacy …

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