Gov. DeSantis’ pharmacy bill advances to House floor despite cost concerns

A top priority of Gov. Ron DeSantis cleared its last House committee and is ready for the chamber floor.

Despite concerns HB 1509 could increase health insurance costs in the commercial market, state group health plans and Medicaid, the committee unanimously approved the bill, which has broad support from hospitals, pharmacists and community pharmacies.

The House bill is similar but not identical to its Senate counterpart (SB 1550) negotiated by Sen. Jason Brodeur. The Senate passed that bill earlier this month.

Though he ultimately voted for the measure, House Health and Human Services Committee Chairman Randy Fine on Monday expressed his worries about the bill and the impact it will have on health insurance costs moving forward.

Fine said the bill will increase access to pharmacists, but may also increase costs.

“I’m not going to stand in the way because I think the issue has been illuminated and people are OK with it. And as long as people are OK with it, then I’m going to be OK with it,” Fine said of the increased costs stemming from the bill. “But I’m going to hope we’re going to continue to work on it as it gets to the floor.”

The House analysis includes comments from a variety of different sources to try to put a price tag on one of the Governor’s priority pieces of legislation.

A Florida Blue actuary estimated that the cost of its “commercial” health plans pharmacy benefits could increase by $81.9 million.

Most of the increase ($65 million) is due to opening pharmacy networks. Pharmacies commonly provide better pricing for narrower networks. An actuary with Sunshine Health Plan estimates the requirement that the managed care plan pharmacy network be broadened would increase its costs by $24 million.

The Department of Management Services, which is in charge of the state group health insurance plan, estimates changes for specialty drugs would increase the state group health insurance plan’s pharmacy costs by $2.2 million.

The committee did agree to tag an amendment onto the bill put forward by Rep. Linda Chaney, the bill’s sponsor. She said the amendment was worked on with the Senate and interested parties.

Florida Association of Health Plans President and CEO Audrey Brown also supported the amendment.

“We believe that many of the cost drivers in the original bill are being addressed by this amendment,” she said.

PCMA senior director of state affairs Connor Rose supported the amendment and thanked Chaney for making the changes. He said the amendment was a “move in the right direction to avoid unintended costs.”

But he also flagged the financial pitfalls of the legislation.

He reminded members of the House Health and Human Services Committee that pharmacy benefit managers (PBMs) work for insurance companies and employers. PBMs negotiate for employers and insurers, develop pharmacy networks and even process payments. But they do not, Rose said, pay the costs of the benefit.

“That benefit is paid for by employers, insurers, state taxpayers. And ultimately any costs associated with this bill — whatever they may be at this point — are ultimately going to be borne by those employers, insurers, state taxpayers and, in time, certainly consumers through the higher premiums or diminished benefits,” he said.

Chaney disputed allegations the bill would increase health care costs.

DeSantis has championed ways that he thinks will lower prescription drug costs for Florida residents. The Governor initially wanted to import drugs from Canada but the federal government has yet to sign off on his plan. DeSantis switched gears last summer issuing an Executive Order on PBMs. DeSantis followed that up in January when he announced some of the details of his proposed plans to regulate PBMs in January.

The Legislature has responded by working on HB 1509 and SB 1550.

Both the House and Senate bills require PBMs to obtain a certificate of authority from the Office of Insurance Regulation (OIR) by Jan. 1, 2024, and require OIR to submit a report to the Governor and Legislature detailing compliance with the law.

The bill also requires drug manufacturers to notify the state of certain increases in drug prices. A drug is reportable if it costs at least $100 to complete a course of treatment and the price increases by 15% or more during the preceding 12 months; or 30% or more over a three-year period.

EMPOWER Patients coalition member and Executive Vice President and CEO of the Florida Pharmacy Association Helen Sairany released a statement following the unanimous vote in the Health and Human Services Committee.

“The EMPOWER Patients coalition appreciates the debate surrounding this important issue that will impact patients throughout Florida. At the end of the day, pharmacy benefit manager reform will make a real, tangible difference in patients’ lives, lowering their costs at the pharmacy counter and increasing access to the prescription drugs they need,” Sairany said in a prepared statement thanking Chaney for the legislation and for “prioritizing patients’ health and wellbeing above all else.”

EMPOWER Patients is composed of the American Pharmacy Cooperative, Aspire Health Pharmacy Services, Florida Independent Pharmacy Network, Florida Pharmacy Association, National Community Pharmacists Association, Pharmacy Provider Services Corporation, Walgreens, and hundreds of patients and independent and community pharmacists and pharmacies across Florida.