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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