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Bills seek to save Florida Medicaid hundreds of millions of dollars, improve prescription drug care for patients

by | Mar 10, 2021


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 save the state.”

Filed last week, SB 1306, called the “Medicaid Pharmacy Benefit Savings Optimization Act,” would require the Agency for Health Care Administration to select a single pharmacy benefit administrator through a competitive procurement process to administer all pharmacy benefits for Medicaid recipients enrolled in managed care plans; require the agency to complete the procurement process and select the pharmacy benefit administrator by a specified date; and prohibit managed care organizations from providing pharmacy benefits for their enrolled members, etc. HB 1043 is very similar.

According to findings in two studies,  the 3Axis and Milliman reports, Florida Medicaid Managed Care is hemorrhaging millions of dollars annually in spread pricing and administrative fees—all of which go directly into PBM out-of-state coffers, and not back into the Florida economy.

“The combination of findings from both the 2020 3Axis Advisors audit and the recent Milliman Report prove that Florida has been unknowingly funneling taxpayer dollars into corporate pharmacy benefit manager (PBM) pockets and out of our state’s economy,” said SPAR founding member and independent pharmacy owner Dawn Butterfield. “We as independent pharmacy owners have been ringing the bell on PBM corporate corruption in our state’s Medicaid program for more than three years. HB 1043/SB 1306 is a strong step in the right direction for Florida taxpayers, patients, and local pharmacies.”

“State studies conducted over the past year prove definitively that the only people in Florida benefiting from pharmacy benefits managers’ control of our current Medicaid system are the PBMs themselves,” said Fine. “Florida has a multi-billion dollar budget deficit. This is a no-brainer way to help close the budgetary gap—improving the quality of service to our state’s Medicaid patients and sav- ing money in the process.”

Fine said, “There will be losers with these bills and it will be the PBMs. But the taxpayer, the recipient, and the local pharmacy will benefit. The people we are here to fight for will benefit.”

“Moving to a fee-for service model will return hundreds of millions of dollars to our state’s economy and dramatically increase the number of pharmacies, too many of which are currently excluded from the managed care plan networks. Our plan to move to a fee-for-service model will benefit Florida’s Medicaid recipients through easier access and availability of their nearest pharmacy,” said Rodriguez. “It’s a win-win solution.”

PBMs see their contribution differently.

“PBMs are working with the entire prescription drug supply chain, including pharmacists, to help patients access needed medications. In fact, PBMs are the only member of the prescription drug supply and payment chain working to lower drug costs,” said The Pharmaceutical Care Management Association (PCMA) Assistant Vice President of Strategic Communications Greg Lopes. “While the state, as the purchaser of PBM services, has the final say on the type of pharmacy benefit model used, it is vitally important that the tools used by PBMs to lower prescription drug costs, such as home delivery of medications and pharmacy networks, are not restricted. When PBM tools are restricted, drug costs increase.”

Lopes continued, “Medicaid is a program that services Florida’s vulnerable population, and should not be, especially during a pandemic, used by independent pharmacies as a place to increase revenue.”

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