Gov. DeSantis orders state to take closer look at pharmacy benefit managers, drug costs

The lawsuit could stand in the way of Florida's plan to import prescription drugs from Canada.

Gov. Ron DeSantis issued an executive order he said will bring more transparency into the role played by pharmacy benefit managers (PBMs) and whether they are the cause of increased prescription drug costs in the state.

DeSantis took the action Friday even as he once again expressed frustration that a Canadian drug importation program he approved has yet to get underway because it has failed to gain final approval from the administration of President Joe Biden.

The drug importation program was pushed with the help of then-House Speaker José Oliva and was signed by DeSantis in 2019. The state has estimated the program could save Floridians between $80 million and $150 million.

The Republican Governor said the state has filed a Freedom of Information Act request with the federal government in search of records that could explain why the importation program — which Biden has previously claimed to support — has yet to get underway.

Florida already has set up a warehouse in Lakeland to help the program operate once it receives federal approval. DeSantis has claimed that once the program is approved, the Agency for Health Care Administration (AHCA) will be able to start importing drugs within 90 days.

“Maybe they just don’t want to give Florida a win and that wouldn’t be surprising,” DeSantis said. “It may be that pharma has told them they don’t want this. But, you know, we’ve got to stop doing policy based on what pharma wants.”

DeSantis also suggested the state could wind up suing the federal government if delays with the importation program continue.

AHCA Secretary Simone Marstiller also complained about the continued delay in the drug importation program, saying she has received a “word salad” from federal officials during meetings to discuss it.

Meanwhile, DeSantis said the executive order will direct state agencies — primarily AHCA and the Department of Management Services, which operate the state Medicaid and state group health insurance programs, respectively — to review contracts with pharmacy benefit managers.

PBMs negotiate with drug manufacturers on behalf of insurance companies in an effort to purchase drugs at reduced prices or with the promise of additional rebates. According to a legislative staff analysis, PBMs are responsible for managing the pharmacy benefits of about 270 million Americans.

Florida requires PBMs to register with the Office of Insurance Regulation. There are 66 PBMs registered in the state. Express Scripts, CVS Caremark, and OptumRx have a combined market share of more than 89%.

DeSantis said he wants the agencies to conduct audits and review any rebate arrangements the state may have regarding prescription drugs.

“This is one additional step. We are looking to do more,” DeSantis said.

A December 2020 audit commissioned by AHCA showed prescription markup tactics employed by PBMs are costing Florida’s Medicaid system at least $90 million each year.