Cutting the astronomical costs of prescription drugs is a bipartisan effort that is being pushed both at the federal and state levels of government, and considering that Florida has a huge and growing retirement community, the need to cut drug costs for those on a fixed retirement income is that much more important.
Sen. Rick Scott (R) and Rep. Debbie Mucarsel-Powell (D) have both vowed to address the costly drug problem, penning their own federal legislation to help curb the issue.
Accessibility to less –expensive drugs is also part of the mix, so it’s not a surprise that state legislators like Rep. Jackie Toledo (R) and others are banning together with healthcare providers to announce legislation (HB 961) that would address the prescription drug cost and accessibility problem in Florida.
Rep. Toledo, alongside Reps. Randy Fine (R), Kamia Brown (D) and Sen. Javier Jose Rodriguez (D) took aim at Pharmacy Benefit Managers (PBMs), that according to a press release, “ side-step free-market principles and force patients to use pharmacies owned by PBM’s – even if the costs are higher.
“Our priority is advocating for Floridians who have felt the pinch in their wallets because profit-driven policies by PBMs are robbing patients of savings that should rightly be theirs,” said Rep. Toledo. “Consumers need to know that their state lawmakers are fighting for their best interests, and our legislation will help put the power back where it belongs: with the patient.”
Rep. Randy Fine (R), is the co-sponsor.
“When pharmaceutical middlemen also own a dominant retail partner, inherent conflicts of interests arise that can lead to reduced competition and increased prices,” said Rep. Randy Fine (R-Palm Bay)
Background
PBMs are secretive prescription drug middlemen in a complex drug marketplace. Originally established to facilitate claims processing, they’ve become more powerful in the healthcare marketplace and now use a convoluted process to reap untold hundreds of millions of dollars when consumers buy their prescription drugs. PBMs negotiate in secret to determine which medications will be covered by insurance plans, and in exchange receive significant pricing discounts – which the PBMS then largely pocket for themselves while patients and plans see increased costs, with patients experiencing a decreased opportunity to choose their own providers and pharmacies, and a growing trend where life-changing medical decisions are made by profit-driven middlemen rather than by patients and physicians.
- Spread Pricing- The difference between what the PBM charges a health plan and how much it reimburses the pharmacy
- Self Dealing- PBMs paying their own pharmacies more per prescription than other network pharmacies and steering patients to the pharmacies they own
- Cost Share- PBMs collecting rebates offered by pharmaceutical companies but then failing to pass the savings on to patients
- Transparency- Requiring that all information, including revenue made by PBMs, be reported to the state or other plan sponsors
- Bad Business Practices- Protecting patient access to medications by keeping our neighborhood pharmacies from being pushed out of business and eliminating anti-competitive practices
