• A Florida Senate committee approved restrictions on pharmacy benefit managers (PBMs) that supports say will boost transparency and give patients more freedom.
• PBM critics argue that their practices are anti-competitive and predatory, with just three PBMs controlling 80% of the prescription market.
• But PBM supporters say the bill is misguided because PBM’s actually improve patient care and reduce healthcare costs by consolidating expenses and delivering services more efficiently.

The Senate Health Policy Committee approved a bill on Monday, aimed at imposing restrictions on pharmacy benefit managers (PBMs), supporting Gov. Ron DeSantis’s priority to increase transparency in the pharmaceutical industry. The bill (SB 1550) would prevent PBMs from requiring patients to use affiliated pharmacies or receive drugs through the mail.

The House Healthcare Regulation Subcommittee is scheduled to consider its version of the legislation (HB 1509) on Tuesday. PBMs, often referred to as “middlemen,” negotiate with drug manufacturers, pay claims, and build pharmacy networks. Independent pharmacies have long criticized PBMs for their practices.

Senate sponsor Jason Brodeur, R-Sanford, emphasized the bill’s focus on transparency. Sen. Gayle Harrell, R-Stuart, echoed the sentiment, stating, “We need to know exactly what is happening. We need to know where our money is going. And we need to make sure that the patient is at the center of what we do.”

However, Connor Rose, senior director of state affairs for the Pharmaceutical Care Management Association, a PBM-industry group, argued that PBMs are employed by employers to negotiate drug prices and develop pharmacy networks. He expressed concern about the legislation leading to “unintended consequences down the line that would result in higher plan costs for employers (and) their employees, who would see those increases in higher premiums, diminished benefits.”

In January 2023, a House Health & Human Services Committee panel heard from pharmacy owners and doctors, who reported that just three PBMs — OptumRx CVS, Caremark, and Express Scripts — controlled 80% of the prescription volume market. Critics argued that PBM practices were anti-competitive and predatory, resulting in decreased patient access to medication and higher consumer costs.

Gov. DeSantis’s proposal includes consumer and small business protections and requires drug manufacturers to disclose proposed price increases before they take effect. The legislation also seeks to implement anti-steering measures to prevent the creation of a pharmaceutical network that only includes PBM-affiliated pharmacies.