Calling for “long overdue reforms,” Gov. Ron DeSantis on Thursday outlined proposed laws that might goal pharmacy profit managers to attempt to decrease prescription-drug prices.
Pharmacy profit managers, or PBMs, are sometimes described as “middlemen” within the health-care system. Working with insurers and different well being plans, they play key roles equivalent to negotiating with drug producers, paying claims and constructing pharmacy networks.
Florida lawmakers in recent times have repeatedly thought-about proposals to position extra laws on PBMs, no less than partly due to complaints by small pharmacies. Lawmakers have handed comparatively modest adjustments, however DeSantis on Thursday indicated he’ll make the difficulty a precedence throughout the 2023 legislative session, which is able to begin in March.
“What we’re going to be doing is we’re going to protect consumers and increase accountability,” DeSantis mentioned throughout an look in The Villages.
The announcement got here amid a collection of efforts in Florida and nationally that supporters say will decrease prescription drug costs. Congress and President Joe Biden, for instance, handed measures final 12 months that can permit Medicare to barter decrease drug costs and capped insulin prices for Medicare beneficiaries.
Also, DeSantis and state lawmakers in 2019 permitted a plan to import cheaper prescription medication from Canada for presidency applications equivalent to Medicaid, prisons and amenities run by the Department of Children and Families. The U.S. Food and Drug Administration, nevertheless, has not signed off on this system, drawing criticism and a lawsuit from the state.
Pharmacy profit managers are main — if typically little-known — gamers within the health-care system. An business group, the Pharmaceutical Care Management Association mentioned on its web site that the businesses administer prescription-drug plans for 266 million folks within the U.S.
The business says it helps decrease prescription prices by means of things like negotiating rebates with drug producers and reductions from pharmacies.
“Using innovative cost-saving tools and technologies, PBMs are working every day on behalf of patients and payers to increase affordability and access to prescription drugs,” the Pharmaceutical Care Management Association web site mentioned.
But the National Association of Chain Drug Stores and the Coalition of Independent and Community Pharmacies issued statements Thursday criticizing PBMs and praising DeSantis’ proposal.
“‘PBM’ should stand for pharmaceutical benefit manipulation because middlemen and payers are profiting at Floridians’ expense,” Steven C. Anderson, president and CEO of the National Association of Chain Drug Stores, mentioned in a ready assertion. “Patients deserve more affordable access to medicines. Patients deserve the best value of care from the pharmacy and pharmacist they choose.”
As of early Thursday afternoon, detailed laws had not been filed. But DeSantis mentioned the proposal will embody:
— Preventing what DeSantis referred to as “spread pricing,” which includes PBMs protecting the distinction between what they’re paid by well being plans and what they pay to pharmacies.
— Preventing a follow generally known as “clawbacks” by PBMs that may cut back cash for pharmacies.
— Barring PBMs from mandating that customers use sure mail-order pharmacies.
Lawmakers throughout the 2022 session handed a measure (HB 357) that sought to extend oversight of PBMs, partly by giving the state Office of Insurance Regulation extra authority over the businesses.
As an instance, PBMs up to now have been required to register with the state, however the Office of Insurance Regulation didn’t have energy to implement the registration requirement. The invoice allowed the Office of Insurance Regulation to wonderful PBMs for violations of the requirement.
DeSantis in July additionally issued an government order that, partly, required audits of PBMs that present providers within the state’s Medicaid managed-care program and the state-employee medical health insurance program.
The government order additionally required state businesses to place sure stipulations in new, renewed or prolonged contracts that contain pharmacy profit managers. For occasion, a kind of stipulations would stop clawbacks.