The Florida House on Friday unanimously approved of a bill authored by Rep. Jackie Toledo (R-Tampa) that would lead to increased oversight of Pharmacy Benefit Managers, who act as middlemen between health insurers and pharmaceutical companies.
The bill, House Bill 357, would grant the Office of Insurance Regulation (OIR) the ability to audit and fine pharmacy benefit managers for violations of the requirements they are held to per their registration with state oversight while also giving pharmacies the ability to appeal audit findings made by health plans and Pharmacy Benefit Managers using American Health Care Association’s existing dispute resolution program. Current law does not permit OIR to hold the necessary power to regulate and enforce adherence to Pharmacy Benefit Managers.
Florida is home to over 1,400 unique independent pharmacies, many of which provide exceptional care and lead to lifelong relationships between patients and their pharmacies. As the relationship between providers, insurance companies, and drug manufacturers has become more complex, the pharmacy benefit manager role was created to help manage claims. As pharmacy claims increased and became more complicated, the power of pharmacy benefit managers (PBMs) increased,” said Toledo. “PBMs, however, have little accountability, which allows them to engage in anti-competitive practices. They have developed formulary lists driven by rebates from manufacturers; encouraged vertical integration of the pharmacy market, thereby reducing competition and dictating costs; and reduced access to care by squeezing independent pharmacies out of business. These numerous, anti-competitive practices are pushing pharmacies that have served communities for generations to the curb.”
Over the past year, the Florida Agency for Health Care Administration tasked a third party to analyze how Florida appropriates money in its Pharmacy Medicaid Managed Care program. It found that in Florida, the state pays its pharmacy providers $58 million and its Pharmacy Benefit Managers $113 million. Of the $113 million, nearly $6 million came from “transaction fees,” which PBMs can charge for any reason they deem necessary, according to an op-ed piece Toledo penne in early 2021.
Toledo’s bill received support from a variety of healthcare groups like the Florida Pharmacy Association and small-pharmacy collective Empower Patients.
We did it! HB 357 relating to Pharmacy Benefit Managers (PBMs) has passed unanimously off the house floor. This bill protects the free market, gives doctors the ability to treat, & lowers the cost of health care/Rx drugs to patients & state of FL 🙌🏼#PBMReform #TheFightContinues pic.twitter.com/4oBmOIa75I
— Jackie Toledo (@ToledoForTampa) February 25, 2022
The Senate Appropriations Committee is scheduled Monday to consider a similar bill (SB 1476), filed by Sen. Tom Wright, R-New Smyrna Beach.