Guest Author
Wouldn’t it be nice if, after your doctor prescribed a particular medication, you could simply go to your favorite pharmacy and pick up the exact medicine chosen by your physician at an affordable price?
Unfortunately, for far too many Floridians, this isn’t how things work in the real world — and countless patients are paying for it with higher prices.
Here’s why: Profit-driven middlemen called Pharmacy Benefit Managers or PBMs, insert themselves between your doctor and your pharmacist, making decisions that can cost you money and push you toward less effective and higher-priced medications. While they were originally created to negotiate better prices and streamline care, PBMs have strayed far from their intended purpose.
But trying to rein in these prescription drug middlemen is a little like playing whack-a-mole. Just when you figure out one issue, another pops up.
Unlike the amusing arcade game, the actions of these predatory middlemen have real consequences that impact families. Through contracts that in theory are supposed to lower health care costs, PBMs can force patients to use less effective medications, steer families to businesses where the PBM will make the biggest profit, divert cost savings away from consumers, and ultimately drive up health care costs for everyone.
For years, these PBMs have had an unrestricted license to manipulate the health care system to maximize their own profits — PBMs rake in more than $300 billion annually.
Fortunately, it looks like momentum is beginning to shift toward a more sensible approach — and it will be patients who benefit.
Across the country, policymakers have increasingly been shining a light on PBMs’ predatory practices, and bipartisan reforms are starting to restore balance to what is now a lopsided system. Here in Florida, Gov. Ron DeSantis recently announced bold plans that may finally put an end to the game of whack-a-mole that’s gone on for far too long.
Now, it’s up to state legislators to put patients back in the driver’s seat.
I have been a practicing rheumatologist for more than 30 years and have worked with countless patients here in the Tampa Bay area. I’ve seen firsthand the despair that comes after I prescribe a particular medication that I know will work best for my patient, but it ends up being rejected by a PBM representative who has never even met the patient. It’s heart-wrenching … and all too common.
Over the years, Florida lawmakers have taken steps to curb these abuses. Five years ago, legislators banned PBM gag orders that prevented pharmacists from telling patients about available prescription drug cost savings. Last year, Florida initiated its first comprehensive audit of PBMs. Those were steps in the right direction, but now it’s time to end the whack-a-mole once and for all by enacting sweeping reforms.
Patient health care must be the top priority, not the profits of operators who don’t actually do anything to help those in need. I hope you will join me in urging Florida lawmakers to act swiftly and put patients first this year.
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Dr. Robert Levin lives in Safety Harbor and serves as advocacy director and is a past president of the Florida Society of Rheumatology.
