Christine Jordan Sexton
The Senate is inching closer to passing a bill that meets Gov. Ron DeSantis’ pledge to increase transparency around consumer drug pricing, reduce the influence of pharmacy benefit managers, and give consumers more say in the pharmacies they use.
Sen. Jason Brodeur’s proposal (SB 1550) was discussed by the full Senate on Tuesday and had two substantive amendments tagged onto it before being rolled to third reading. The Senate can take the measure and pass it out of the chamber as early as Wednesday. The House must still pass the bill.
The bill initially banned PBMs from requiring patients to receive a prescription drug by mail, unless the prescription drug cannot be acquired at any retail pharmacy in the PBM’s network for the covered person’s plan or program. But the bill contained an exemption that allowed PBMs to continue operating mail-order programs on an opt-in basis at the sole discretion of a covered person.
One of the amendments adopted on Tuesday changed the mail-order exemption from an opt-out provision to an opt-in requirement.
The amendment also tightened language regarding the development of specialty pharmacy networks.
The bill initially authorized PBMs to establish specialty networks with enhanced safety and competency standards for drugs that require extraordinary special handling and, among other requirements, are subject to a risk evaluation and mitigation strategy approved by the U.S. Food and Drug Administration.
Brodeur’s amendment, however, deleted the ability for PBMs to develop specialty networks for drugs that require cold chain storage and shipping or specialized equipment to dispense; or require other conditions of similar gravity.
Helen Sairany, Executive Vice President and CEO of the Florida Pharmacy Association released a statement Tuesday thanking Brodeur for the changes.
“We look forward to seeing the amended SB 1550 continue to move throughout the legislative process with favorable support, codifying long-overdue provisions to rein in PBMs, as well as important consumer and small business protections.,” she said.
Brodeur has described the bill as a consumer protection measure and said that it’s not meant to benefit the pharmaceutical industry, independent pharmacists and pharmacies or PBMs, often referred to as the pharmacy “middle men.”
A staff analysis indicates some of the bill’s provisions may prohibit PBMs from “employing mechanisms designed to reduce costs of prescription drugs for insurers, HMOs, and other pharmacy benefits plans and programs, which could have the effect of increasing premiums and/or other costs for such payers or for persons with individual coverage. The extent of such an effect is indeterminate.”
The analysis estimates that the provisions, which apply to the state group health insurance program, will increase the costs of that benefit plan by as much as $2.2 million.
Given the caution over rising costs, Broduer offered an amendment that made clear the provision of the bill does not impact workers’ compensation benefits.
The bill requires PBMs to pass on 100% of all manufacturer rebates they receive to the plan or program if the contractual arrangement delegates rebate negotiations to PBMs for the sole purpose of offsetting defined cost sharing and reducing premium costs.
Medicaid managed care plans are exempt from the requirement because those rebates are returned to the state.
Pharmacy benefit managers are also required to offer contracts to the onsite pharmacies at Medicaid “essential providers,” solely for the administration and dispensation of covered prescription drugs, including biologics, that are administered through infusion, injection, or inhalation during surgical procedures, or a covered parenteral drug as part of onsite outpatient care.
The same contract requirements apply to the onsite pharmacies at Designated Cancer Centers of Excellence, organ transplant hospitals, specialty children’s hospitals, or regional perinatal intensive care centers.
The bill requires prescription drug manufacturers and nonresident prescription drug manufacturers to disclose reportable prescription drug price increases so the state can publish them on a website. Drugs that cost $100 or more for a course of treatment are defined as reportable.
For reportable drugs, the bill requires the manufacturers to report any increase of 15% or more of the wholesale acquisition cost over the past 12 months; or any increase of 30% or more of the wholesale acquisition cost over the past three calendar years.
The bill also requires PBMs to obtain a certificate of authority for an administrator with the state insurance department.
