With the first committee week of the 2023 Florida legislative session has come to an end, there is ongoing talk among political circles in Tallahassee that the pharmacy benefit manager (PBM) argument and prescription drug prices, could be one of the focal point issues lawmakers will have to address.
It's still very early in the legislative process, but Gov. Ron DeSantis could seek to put this issue in his rearview mirror soon after the legislative session begins in March.
DeSantis has an unquestionable mandate, and with Republicans holding a supermajority in the state legislature, expect DeSantis o get his way on just about every issue.
In July 2022, Governor DeSantis tipped his hand on where he stood on the issue.
DeSantis’s Executive Order 22-164 was a strong step to bring more transparency to the middleman role pharmacy benefit managers currently hold.
Because PBM’s run as a go-between for insurance companies and those who benefit from managed prescription drug benefits, DeSantis wants to make sure that consumers are getting the most bang for their prescription drug buck.
“Spread pricing is a deceptive practice where PBMs collect payment from the individual and keep leftover funds after they’ve already reimbursed the pharmacy for the prescription and the service cost. The practice essentially adds a middle man and that practice drives up the cost for everyday Floridians,” said DeSantis.“Claw backs occur when an individual overpays for their prescription and the PBMs keep the overpayment as a financial bonus.”
An audit commissioned by the Florida Agency for Health Care Administration (AHCA) shows that PBM prescription drug markup activity, including spread costs and administrative and other fees, cost the state’s Medicaid system more than $113 million dollars in 2020 alone.
